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Højsgaard Chow H, Petersen ER, Olsson A, Hejgaard Laursen J, Bredahl Hansen M, Oturai AB, Soelberg Sørensen P, Bach Søndergaard H, Sellebjerg F. Age-corrected neurofilament light chain ratio decreases but does not predict relapse in highly active multiple sclerosis patients initiating natalizumab treatment. Mult Scler Relat Disord 2024; 88:105701. [PMID: 38889559 DOI: 10.1016/j.msard.2024.105701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/23/2024] [Accepted: 06/02/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Neurofilament light chain (NFL) is a biomarker for monitoring disease activity and treatment response in multiple sclerosis (MS). However, while most agree that NFL levels predict disease activity and worsening, the predictive value of NFL on future relapse risk remains uncertain. OBJECTIVE The primary aim was to evaluate the predictive value of age-corrected serum NFL (sNFL) ratio on relapse risk in highly active relapsing-remitting MS patients (RRMS) treated with natalizumab. A secondary aim was to investigate the predictive value of sNFL ratios for MRI activity. METHODS From January 1, 2006, to December 31, 2010, 355 patients initiated natalizumab treatment at the Danish Multiple Sclerosis Center. 305 patients were anti-natalizumab antibodies negative and had at least one blood sample available for sNFL analysis using single molecule array analysis at baseline, three, six, or 12 months. The patients were either treatment-naïve (n = 8), switching from interferon-β or glatiramer acetate (n = 253), or switching from mitoxantrone (n = 44). An age-corrected ratio was calculated for sNFL. Time to first relapse was calculated from baseline and after re-baseline at 90 days. Data were collected from baseline until the two-year follow-up or end of treatment and included disease duration, expanded disability status scale, previous treatments, relapses 12 months prior to natalizumab initiation, smoking intensity, body mass index, and body weight. In addition, the patients underwent annual MRI of the brain. RESULTS The sNFL ratio was increased in 173 of 287 samples (60.3 %) at baseline, in 119 of 246 samples (48.8 %) at month three, in 109 of 287 samples (38.0 %) at month six, and in 82 of 270 samples (30.4 %) at month 12. The sNFL ratio continuously declined over 12 months with significant decreases for every measuring timepoint: baseline vs. three months p = 3.0 × 10-6; three months vs. six months p = 3.2 × 10-5; six months vs. 12 months p = 0.002. Univariate Cox regression analysis showed that time to first relapse from 1) natalizumab initiation and from 2) re-baseline was associated with the number of relapses in the previous 12 months (hazard ratio 1.31 per relapse, 95 % CI = 1.2-1.5, p = 2.0 × 10-6; and 1.21 per relapse, 95 % CI = 1.1-1.4, p = 0.002, respectively). sNFL ratio at re-baseline was negatively associated with relapse risk (hazard ratio 0.82 per unit; 95 % CI = 0.7-1.0; p = 0.049). A multivariable Cox regression analysis of relapse risk from re-baseline showed that the number of relapses in the 12 months prior to natalizumab treatment (hazard ratio 1.29; 95 % CI = 1.1-1.5; p = 6.0 × 10-4) and smoking (hazard ratio 1.51 per 20 cigarettes per day; 95 % CI = 1.0-2.2; p = 0.030) were associated with increased risk of relapse; sNFL ratio was associated with a lower risk of relapse (hazard ratio = 0.736 per unit; 95 % CI = 0.6-0.9 p = 0.007). In univariate logistic regression analyses, the sNFL ratio at 12 months and values above the 75th and the 90th percentile predicted MRI activity in the following year (odds ratio [OR] = 2.0, 95 % CI = 1.2-3.6, p = 0.012; OR = 2.2, 95 % CI = 1.2-4.1, p = 0.014; and OR = 2.8, 95 % CI = 1.1-6.7, p = 0.026). CONCLUSION In this highly active RRMS cohort, high sNFL ratios reflected previous relapse activity and decreased after initiation of treatment but were not associated with increased relapse risk in the following two years. Pre-treatment relapses and smoking on treatment were predictors of relapse risk after re-baselining at 90 days. MRI activity in year two was predicted by sNFL ratios at month 12.
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Affiliation(s)
- Helene Højsgaard Chow
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark.
| | - Eva Rosa Petersen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - Anna Olsson
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - Julie Hejgaard Laursen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - Malene Bredahl Hansen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - Annette Bang Oturai
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - Per Soelberg Sørensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - Helle Bach Søndergaard
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
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Gelibter S, Saraceno L, Pirro F, Susani EL, Protti A. As time goes by: Treatment challenges in elderly people with multiple sclerosis. J Neuroimmunol 2024; 391:578368. [PMID: 38761652 DOI: 10.1016/j.jneuroim.2024.578368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/11/2024] [Accepted: 05/12/2024] [Indexed: 05/20/2024]
Abstract
A demographic shift in multiple sclerosis (MS) is leading to an increased number of elderly people with MS (pwMS) and a rise in late-onset MS (LOMS) cases. This shift adds complexity to the treatment management of these patients, due to enhanced treatment-associated risks and the possible interplay between immunosenescence and disease-modifying therapies (DMTs). In the present paper, we performed a systematic review of the current evidence concerning the relationship between aging and treatment management in elderly pwMS. Our literature search identified 35 original studies relevant to this topic. The gathered evidence consistently indicates a diminished efficacy of DMTs in older pwMS, particularly in preventing disability accrual. Against this background, high-efficacy therapies (HETs) appear to show less benefit over moderate-low-efficacy DMTs in older patients. These data mainly derive from observational retrospective studies or meta-analyses conducted on randomized clinical trials (RCTs). RCTs, however, exclude pwMS older than 55 years, limiting our ability to acquire robust evidence regarding this patient group. Regarding treatment discontinuation in elderly pwMS with stable disease, the available data, which mainly focuses on older injectable DMTs, suggests that their suspension appears to be relatively safe in terms of disease activity. Nevertheless, the first RCT specifically targeting treatment discontinuation recently failed to demonstrate the non-inferiority of treatment discontinuation over continuation, in terms of MRI activity. On the other hand, the evidence on the impact of discontinuation on disease progression is more conflicting and less robust. Furthermore, there is an important lack of studies concerning sequestering DMTs and virtually no data on the discontinuation of anti-CD20 monoclonal antibodies. De-escalation strategy is gaining attention as a de-risking approach alternative to complete treatment discontinuation. It may be defined as the decision to shift from HETs to less potent DMTs in elderly pwMS who have a stable disease. This strategy could reduce treatment-related risks, while minimizing the risk of disease activity and progression potentially associated with treatment discontinuation. This approach, however, remains unexplored due to a lack of studies. Given these findings, the present scenario underlines the urgent need for more comprehensive and robust studies to develop optimized, data-driven treatment strategies for elderly pwMS and LOMS, addressing the unique challenges of MS treatment and aging.
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Affiliation(s)
- Stefano Gelibter
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Lorenzo Saraceno
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fiammetta Pirro
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Emanuela Laura Susani
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandra Protti
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Prosperini L, Haggiag S. Late-onset multiple sclerosis from a different angle. Mult Scler 2024; 30:765-766. [PMID: 38717100 DOI: 10.1177/13524585241249901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Affiliation(s)
- Luca Prosperini
- MS Centre, Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Shalom Haggiag
- MS Centre, Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
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Fernández Ó, Sörensen PS, Comi G, Vermersch P, Hartung HP, Leocani L, Berger T, Van Wijmeersch B, Oreja-Guevara C. Managing multiple sclerosis in individuals aged 55 and above: a comprehensive review. Front Immunol 2024; 15:1379538. [PMID: 38646534 PMCID: PMC11032020 DOI: 10.3389/fimmu.2024.1379538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Multiple Sclerosis (MS) management in individuals aged 55 and above presents unique challenges due to the complex interaction between aging, comorbidities, immunosenescence, and MS pathophysiology. This comprehensive review explores the evolving landscape of MS in older adults, including the increased incidence and prevalence of MS in this age group, the shift in disease phenotypes from relapsing-remitting to progressive forms, and the presence of multimorbidity and polypharmacy. We aim to provide an updated review of the available evidence of disease-modifying treatments (DMTs) in older patients, including the efficacy and safety of existing therapies, emerging treatments such as Bruton tyrosine kinase (BTKs) inhibitors and those targeting remyelination and neuroprotection, and the critical decisions surrounding the initiation, de-escalation, and discontinuation of DMTs. Non-pharmacologic approaches, including physical therapy, neuromodulation therapies, cognitive rehabilitation, and psychotherapy, are also examined for their role in holistic care. The importance of MS Care Units and advance care planning are explored as a cornerstone in providing patient-centric care, ensuring alignment with patient preferences in the disease trajectory. Finally, the review emphasizes the need for personalized management and continuous monitoring of MS patients, alongside advocating for inclusive study designs in clinical research to improve the management of this growing patient demographic.
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Affiliation(s)
- Óscar Fernández
- Departament of Pharmacology, Faculty of Medicine; Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital of Malaga, Malaga, Spain
- Department of Pharmacology and Pediatry, Faculty of Medicine, University of Malaga, Malaga, Spain
| | - Per Soelberg Sörensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Copenhagen and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Giancarlo Comi
- Department of Neurorehabilitation Sciences, Multiple Sclerosis Centre Casa di Cura Igea, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Patrick Vermersch
- Univ. Lille, Inserm U1172 LilNCog, CHU Lille, FHU Precise, Lille, France
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- Brain and Mind Center, University of Sydney, Sydney, NSW, Australia
- Department of Neurology, Palacky University Olomouc, Olomouc, Czechia
| | - Letizia Leocani
- Department of Neurorehabilitation Sciences, Multiple Sclerosis Centre Casa di Cura Igea, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Bart Van Wijmeersch
- University MS Centre, Hasselt-Pelt, Belgium
- Rehabilitation and Multiple Sclerosis (MS), Noorderhart Hospitals, Pelt, Belgium
| | - Celia Oreja-Guevara
- Department of Neurology, Hospital Clínico Universitario San Carlos, IdISSC, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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Barzegar M, Vaheb S, Mirmosayyeb O, Ashtari F, Afshari-Safavi A, Adibi I, Shaygannejad A, Mazaheri S, Rahimi M, Shaygannejad V. Prevalence and incidence of multiple sclerosis in Isfahan, Iran between 1996 and 2021: A population-based study. Mult Scler Relat Disord 2024; 84:105479. [PMID: 38359695 DOI: 10.1016/j.msard.2024.105479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/18/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND There has been no recent comprehensive epidemiological study on a large and stable population of multiple sclerosis (MS) in Isfahan. Therefore, we conducted this study to estimate the incidence and prevalence of MS in Isfahan province from 1996 to 2021. METHOD In this population-based study, we utilized the dataset from the Vice-Chancellor's Office of Isfahan University of Medical Sciences, which registers all people diagnosed with MS (PDWM) in Isfahan province, excluding those residing in Kashan city. We measured crude incidence and prevalence of MS, separated by sex, and based on age of MS onset, as well as changes in age of MS onset during observation. RESULTS A total of 9,909 PDWM were included in our study. The incidence during the time period of 1996-2000 was 5.4/100,000 (1.1/100,000 per year), which subsequently increased to 14.1 (2.8/100,000 per years) and 31.1 per 100,000 (6.2/100,000 per year) during 2001-2005 and 2006-2010, respectively. There was a further increase to 70.9/100,000 (14.2/100,000 per year) in 2011-2015, but it remained stable at 71.8/100,000 (12/100,000 per year) during the period of 2016-2021. In 2016, the age-standardized incidence rates of pediatric-onset, adult-onset, and late-onset MS were 1.8/100,000, 31.4/100,000, and 17.5/100,000, respectively. The prevalence of MS in 2021 was 183.9/100,000. The female/male new case ratio was 4.5 during 1996-2000, decreasing to 4.0, 3.9, 3.9, and 2.9 in the subsequent four five-year periods. The mean age of RRMS onset was 26.3 ± 8.1 between 1990 and 1999, 28.5 ± 8.3 during 2000-2009, and increased to 32.8 ± 9.6 in 2010-2019. CONCLUSION This study shows that Isfahan has one of the highest incidence rate and prevalence ratio of MS in the region. We observed an increase in the incidence rate during the first decade, followed by stability in the last two five- and six-year periods. Further studies are needed to identify the reasons behind the change in incidence of MS in Iran.
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Affiliation(s)
- Mahdi Barzegar
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Vaheb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mirmosayyeb
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Ashtari
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Afshari-Safavi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Iman Adibi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aysa Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahrbanoo Mazaheri
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Rahimi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Habbestad A, Willumsen JS, Aarseth JH, Grytten N, Midgard R, Wergeland S, Myhr KM, Torkildsen Ø. Increasing age of multiple sclerosis onset from 1920 to 2022: a population-based study. J Neurol 2024; 271:1610-1617. [PMID: 38097800 PMCID: PMC10973050 DOI: 10.1007/s00415-023-12047-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To study the age at onset of relapsing-remitting multiple sclerosis (RRMS) during the past century. METHODS This is a population-based cohort study of persons diagnosed with RRMS in Hordaland, Møre, and Romsdal counties, Western Norway, from 1920 to 2022. Individual patient data were available and assessed from previously conducted prevalence and incidence studies in addition to hospital records up until October 31, 2022. Participants were categorized according to onset period and analyzed for temporal trends in age at onset, time from onset to diagnosis, and distribution of onset over time. RESULTS We identified 3364 persons with confirmed RRMS. The mean age at onset significantly increased (p < 0.001) throughout the study period, despite a decrease in time from symptom onset to diagnosis (p < 0.001). The proportion of persons with MS onset after 50 years of age increased from 2.6% before 1970 to 11.9% after 2010. We also found a trend toward a bimodal distribution of age at onset that peaked at around 30 years and 40-45 years of age in the latest period. CONCLUSION Age at onset of MS significantly increased throughout the study period. This was mainly due to an increasing number of persons with MS, predominantly female, experiencing onset after 40-45 years of age. This bimodal distribution could indicate different susceptibility periods of MS or changes in exposure to risk factors during the observation period.
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Affiliation(s)
- A Habbestad
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - J S Willumsen
- Department of Neurology, Molde Hospital, Molde, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - J H Aarseth
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
- Norwegian Multiple Sclerosis Registry and Biobank, Haukeland University Hospital, Bergen, Norway
| | - N Grytten
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - R Midgard
- Department of Neurology, Molde Hospital, Molde, Norway
| | - S Wergeland
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Norwegian Multiple Sclerosis Registry and Biobank, Haukeland University Hospital, Bergen, Norway
| | - K M Myhr
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ø Torkildsen
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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Lorefice L, Ferraro OE, Fenu G, Amato MP, Bresciamorra V, Conte A, De Luca G, Ferraro D, Filippi M, Gazzola P, Iaffaldano P, Inglese M, Lus G, Marfia GA, Patti F, Pesci I, Salemi G, Trojano M, Zaffaroni M, Monti MC, Cocco E. Late-onset multiple sclerosis: disability trajectories in relapsing-remitting patients of the Italian MS Registry. J Neurol 2024; 271:1630-1637. [PMID: 38172380 DOI: 10.1007/s00415-023-12152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Generally infrequent, multiple sclerosis (MS) with late onset (LOMS) is characterized by an onset over the age of 50 and a mainly progressive course, while relapsing-remitting (RR) forms are less frequently observed and explored. This study aimed to characterize a large cohort of MS patients with RRMS at onset to assess the baseline factors related to the worst disability trajectories and explore the role of LOMS. METHODS The data were extracted from the Italian MS Register (IMSR). Disability trajectories, defined using at least two and up to twenty expanded disability status scale (EDSS) assessments annually performed, were implemented using group-based trajectory models (GBTMs) to identify different groups with the same trajectories over time. MS profiles were explored using multinomial logistic regression. RESULTS A total of 16,159 RR patients [1012 (6.26%) presented with LOMS] were analyzed. The GBTM identified four disability trajectories. The group with the most severe EDSS trend included 12.3% of the patients with a mean EDSS score > 4, which increased over time and exceeded 6 score. The group with medium severity EDSS trend comprised 21.9% of the patients and showed a change in EDSS > 3 scores over time. The largest group with 50.8% of patients reported a constant EDSS of 2 score. Finally, the benign group comprised 14.9% of the patients with a low and constant EDSS of 1 score over time. The probability of being in the worst groups increased if the patient was male; had LOMS or experienced brainstem, spinal, or supratentorial symptoms. CONCLUSIONS Four MS severity profiles among RRMS patients in the IMSR have been reported, with LOMS being associated with a rapid worsening of EDSS scores. These findings have important implications for recognizing and managing how older age, aging, and age-related factors interact with MS and its evolution.
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Affiliation(s)
- Lorena Lorefice
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, University of Cagliari, ASL Cagliari, via Is Guadazzonis 2, PO Binaghi, 01916, Cagliari, Italy.
| | - Ottavia Elena Ferraro
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy
| | - Giuseppe Fenu
- Department of Neurosciences, ARNAS Brotzu, Cagliari, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Vincenzo Bresciamorra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Multiple Sclerosis Clinical Care and Research Centre, University of Naples "Federico II", Naples, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Giovanna De Luca
- Multiple Sclerosis Centre, Neurology Unit, SS. Annunziata Hospital University "G D'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Diana Ferraro
- Department of Neurosciences, Civil Hospital of Baggiovara, AOU of Modena, Baggiovara, Italy
| | - Massimo Filippi
- Neurology, Neurorehabilitation and Neuroimaging Research Units, Neurophysiology Service, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Gazzola
- Neurology Unit, P.A. Micone Hospital, ASL3 Genovese, Genoa, Italy
| | - Pietro Iaffaldano
- Department of Translational Biomedicine and Neurosciences, DiBraiN University of Bari Aldo Moro, Bari, Italy
| | - Matilde Inglese
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno - Infantili (DINOGMI), Universita' Di Genova, Genoa, Liguria, Italy
| | - Giacomo Lus
- Multiple Sclerosis Center, Second Division of Neurology, Department of Advanced Medical and Surgical Science, University of Campania Luigi Vanvitelli, 80131, Naples, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, 00133, Rome, Italy
| | - Francesco Patti
- Department Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
| | - Ilaria Pesci
- Centro Sclerosi Multipla Unità Operativa Neurologia, Azienda Unità Sanitaria Locale, Ospedale Di Vaio, Fidenza, Parma, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, Hospital of Gallarate - ASST Della Valle Olona, Gallarate, Italy
| | - Maria Cristina Monti
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, University of Cagliari, ASL Cagliari, via Is Guadazzonis 2, PO Binaghi, 01916, Cagliari, Italy
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Mouresan EF, Mentesidou E, Berglund A, McKay KA, Hillert J, Iacobaeus E. Clinical Characteristics and Long-Term Outcomes of Late-Onset Multiple Sclerosis: A Swedish Nationwide Study. Neurology 2024; 102:e208051. [PMID: 38394472 PMCID: PMC11033980 DOI: 10.1212/wnl.0000000000208051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/23/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Clinical onset of multiple sclerosis (MS) after the age of 50 years is uncommon and associated with a less favorable natural history. The differences in long-term outcomes in patients with late-onset MS (LOMS, onset 50 years or older) and adult-onset MS (AOMS, onset 18 years or older and younger than 50 years) during the disease-modifying therapy (DMT) era have been less studied. This study aimed to compare patient characteristics, DMT exposure, and disability progression in Swedish patients with LOMS and AOMS over 2 decades (2001-2022). METHODS The nationwide Swedish MS registry was searched for patients with an onset of MS between January 1, 2001, and December 31, 2018, with symptom onset at age 18 years or older and ≥2 recorded Expanded Disability Status Scale (EDSS) scores. Clinical and demographic parameters and exposure to DMT were compared between LOMS and AOMS. Time to disability milestones (EDSS 4 and 6) was assessed using Kaplan-Meier curves and Cox proportional hazards regression models adjusted for sex, disease course, calendar year at onset, and DMT exposure. RESULTS Among 8739 patients with MS who met inclusion criteria, 1,028 (11.8%) were LOMS. Primary progressive MS was more frequently diagnosed in LOMS compared with that in AOMS (25.2% vs 4.5%; p < 0.001). Most of the patients had been prescribed DMT, but more rarely in LOMS compared with AOMS (74.7% vs 95.6%; p < 0.001). Less than half of patients with LOMS had been exposed to a high-efficacy DMT (45.8%) compared with 73.5% of AOMS (p < 0.001). The risk of reaching disability milestones was greater for LOMS compared with that for AOMS (EDSS 4; adjusted hazard ratio [aHR] 2.71; 95% CI 2.22-3.30; p < 0.001, and EDSS 6; aHR 2.67; 95% CI 2.12-3.36; p < 0.001). DISCUSSION This study distinguishes LOMS as a particularly vulnerable group and clinically supports close vigilance of these patients. Further studies are needed to assess and clarify the benefit of DMT usage in older adults with MS.
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Affiliation(s)
- Elena F Mouresan
- From the Department of Clinical Neuroscience (E.F.M., E.M., A.B., K.A.M., J.H., E.I.), and Centre for Molecular Medicine (J.H.), Karolinska Institutet; and Department of Neurology (E.M., K.A.M., E.I.), Stockholm, Sweden
| | - Eleni Mentesidou
- From the Department of Clinical Neuroscience (E.F.M., E.M., A.B., K.A.M., J.H., E.I.), and Centre for Molecular Medicine (J.H.), Karolinska Institutet; and Department of Neurology (E.M., K.A.M., E.I.), Stockholm, Sweden
| | - Anders Berglund
- From the Department of Clinical Neuroscience (E.F.M., E.M., A.B., K.A.M., J.H., E.I.), and Centre for Molecular Medicine (J.H.), Karolinska Institutet; and Department of Neurology (E.M., K.A.M., E.I.), Stockholm, Sweden
| | - Kyla A McKay
- From the Department of Clinical Neuroscience (E.F.M., E.M., A.B., K.A.M., J.H., E.I.), and Centre for Molecular Medicine (J.H.), Karolinska Institutet; and Department of Neurology (E.M., K.A.M., E.I.), Stockholm, Sweden
| | - Jan Hillert
- From the Department of Clinical Neuroscience (E.F.M., E.M., A.B., K.A.M., J.H., E.I.), and Centre for Molecular Medicine (J.H.), Karolinska Institutet; and Department of Neurology (E.M., K.A.M., E.I.), Stockholm, Sweden
| | - Ellen Iacobaeus
- From the Department of Clinical Neuroscience (E.F.M., E.M., A.B., K.A.M., J.H., E.I.), and Centre for Molecular Medicine (J.H.), Karolinska Institutet; and Department of Neurology (E.M., K.A.M., E.I.), Stockholm, Sweden
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Knowles S, Middleton R, Cooze B, Farkas I, Leung YY, Allen K, Winslade M, Owen DRJ, Magliozzi R, Reynolds R, Neal JW, Pearson O, Nicholas R, Pickrell WO, Howell OW. Comparing the Pathology, Clinical, and Demographic Characteristics of Younger and Older-Onset Multiple Sclerosis. Ann Neurol 2024; 95:471-486. [PMID: 38061895 DOI: 10.1002/ana.26843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Older people with multiple sclerosis (MS) have a less active radiological and clinical presentation, but many still attain significant levels of disability; but what drives worsening disability in this group? METHODS We used data from the UK MS Register to characterize demographics and clinical features of late-onset multiple sclerosis (LOMS; symptom onset at ≥50 years), compared with adult-onset MS (AOMS; onset 18-49 years). We performed a pathology study of a separate MS cohort with a later onset (n = 18, mean age of onset 54 years) versus AOMS (n = 23, mean age of onset 29 years). RESULTS In the Register cohort, there were 1,608 (9.4%) with LOMS. When compared with AOMS, there was a lower proportion of women, a higher proportion of primary progressive MS, a higher level of disability at diagnosis (median MS impact scale 36.7 vs. 28.3, p < 0.001), and a higher proportion of gait-related initial symptoms. People with LOMS were less likely to receive a high efficacy disease-modifying treatment and attained substantial disability sooner. Controlling for age of death and sex, neuron density in the thalamus and pons decreased with onset-age, whereas actively demyelinating lesions and compartmentalized inflammation was greatest in AOMS. Only neuron density, and not demyelination or the extent of compartmentalized inflammation, correlated with disability outcomes in older-onset MS patients. INTERPRETATION The more progressive nature of older-onset MS is associated with significant neurodegeneration, but infrequent inflammatory demyelination. These findings have implications for the assessment and treatment of MS in older people. ANN NEUROL 2024;95:471-486.
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Affiliation(s)
- Sarah Knowles
- UK MS Register, Swansea University Medical School, Swansea University, Swansea, UK
| | - Rod Middleton
- UK MS Register, Swansea University Medical School, Swansea University, Swansea, UK
| | - Benjamin Cooze
- Department of Neurosciences, Swansea University Medical School, Swansea University, Swansea, UK
| | - Ildiko Farkas
- Division of Brain Sciences, Imperial College London, London, UK
| | | | - Kelsey Allen
- Department of Neurosciences, Swansea University Medical School, Swansea University, Swansea, UK
| | - Molly Winslade
- Department of Neurosciences, Swansea University Medical School, Swansea University, Swansea, UK
| | - David R J Owen
- Division of Brain Sciences, Imperial College London, London, UK
| | - Roberta Magliozzi
- Division of Brain Sciences, Imperial College London, London, UK
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | | | - James W Neal
- Department of Neurosciences, Swansea University Medical School, Swansea University, Swansea, UK
| | - Owen Pearson
- Neurology Department, Morriston Hospital, Swansea Bay University Health Board, Port Talbot, UK
| | - Richard Nicholas
- UK MS Register, Swansea University Medical School, Swansea University, Swansea, UK
- Division of Brain Sciences, Imperial College London, London, UK
| | - W Owen Pickrell
- Department of Neurosciences, Swansea University Medical School, Swansea University, Swansea, UK
- Neurology Department, Morriston Hospital, Swansea Bay University Health Board, Port Talbot, UK
| | - Owain W Howell
- Department of Neurosciences, Swansea University Medical School, Swansea University, Swansea, UK
- Division of Brain Sciences, Imperial College London, London, UK
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10
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Kalakh S, Mouihate A. The Effects of Neuroactive Steroids on Myelin in Health and Disease. Med Princ Pract 2024; 33:198-214. [PMID: 38350432 PMCID: PMC11175611 DOI: 10.1159/000537794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/12/2024] [Indexed: 02/15/2024] Open
Abstract
Myelin plays a pivotal role in the efficient transmission of nerve impulses. Disruptions in myelin integrity are associated with numerous neurological disorders, including multiple sclerosis. In the central nervous system (CNS), myelin is formed by oligodendrocytes. Remyelination refers to the re-formation of the damaged myelin sheath by newly formed oligodendrocytes. Steroids have gained attention for their potential modulatory effects on myelin in both health and disease. Steroids are traditionally associated with endocrine functions, but their local synthesis within the nervous system has generated significant interest. The term "neuroactive steroids" refers to steroids that can act on cells of the nervous system. In the healthy state, neuroactive steroids promote myelin formation, maintenance, and repair by enhancing oligodendrocyte differentiation and maturation. In pathological conditions, such as demyelination injury, multiple neuroactive steroids have shown promise in promoting remyelination. Understanding the effects of neuroactive steroids on myelin could lead to novel therapeutic approaches for demyelinating diseases and neurodegenerative disorders. This review highlights the potential therapeutic significance of neuroactive steroids in myelin-related health and diseases. We review the synthesis of steroids by neurons and glial cells and discuss the roles of neuroactive steroids on myelin structure and function in health and disease. We emphasize the potential promyelinating effects of the varying levels of neuroactive steroids during different female physiological states such as the menstrual cycle, pregnancy, lactation, and postmenopause.
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Affiliation(s)
- Samah Kalakh
- Department of Physiology, College of Medicine, Kuwait University, Kuwait City, Kuwait
- School of Engineering and Computing, American International University, Kuwait City, Kuwait
| | - Abdeslam Mouihate
- Department of Physiology, College of Medicine, Kuwait University, Kuwait City, Kuwait
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11
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Meng Q, Cui E, Leroux A, Mowry EM, Lindquist MA, Crainiceanu CM. Quantifying the Association between Objectively Measured Physical Activity and Multiple Sclerosis in the UK Biobank. Med Sci Sports Exerc 2023; 55:2194-2202. [PMID: 37535318 PMCID: PMC10822027 DOI: 10.1249/mss.0000000000003260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
INTRODUCTION Objectively measured physical activity (PA) data were collected in the accelerometry substudy of the UK Biobank. UK Biobank also contains information about multiple sclerosis (MS) diagnosis at the time of and after PA collection. This study aimed to 1) quantify the difference in PA between prevalent MS cases and matched healthy controls, and 2) evaluate the predictive performance of objective PA measures for incident MS cases. METHODS The first analysis compared eight accelerometer-derived PA summaries between MS patients ( N = 316) and matched controls (30 controls for each MS case). The second analysis focused on predicting time to MS diagnosis among participants who were not diagnosed with MS. A total of 19 predictors including eight measures of objective PA were compared using Cox proportional hazards models (number of events = 47; 585,900 person-years of follow-up). RESULTS In the prevalent MS study, the difference between MS cases and matched controls was statistically significant for all PA summaries ( P < 0.001). In the incident MS study, the most predictive variable of progression to MS in univariate Cox regression models was lower age ( C = 0.604), and the most predictive PA variable was lower relative amplitude (RA, C = 0.594). A two-stage forward selection using Cox regression resulted in a model with concordance C = 0.693 and four predictors: age ( P = 0.015), stroke ( P = 0.009), Townsend deprivation index ( P = 0.874), and RA ( P = 0.004). A model including age, stroke, and RA had a concordance of C = 0.691. CONCLUSIONS Objective PA summaries were significantly different and consistent with lower activity among study participants who had MS at the time of the accelerometry study. Among individuals who did not have MS, younger age, stroke history, and lower RA were significantly associated with a higher risk of a future MS diagnosis.
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Affiliation(s)
- Qier Meng
- Department of Biostatistics, Johns Hopkins University,
Baltimore, MD
| | - Erjia Cui
- Department of Biostatistics, Johns Hopkins University,
Baltimore, MD
- Division of Biostatistics, University of Minnesota,
Minneapolis, MN
| | - Andrew Leroux
- Department of Biostatistics and Informatics, Colorado
School of Public Health, Aurora, CO
| | - Ellen M. Mowry
- School of Medicine, Johns Hopkins University, Baltimore,
MD
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12
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Skarlis C, Papadopoulos V, Raftopoulou S, Mavragani CP, Evangelopoulos ME. B-cell activating factor gene variants in multiple sclerosis: Possible associations with disease susceptibility among females. Clin Immunol 2023; 257:109847. [PMID: 37995946 DOI: 10.1016/j.clim.2023.109847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/24/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
Although B cells and B cell activating factor (BAFF) have been previously implicated in MS pathogenesis, data regarding the genetic influence of BAFF polymorphisms on MS susceptibility are limited. Here we aim to explore whether BAFF polymorphisms could contribute to MS susceptibility. 156 RRMS patients fulfilling the revised McDonald criteria for MS diagnosis and 220 HCs were enrolled. Clinical, laboratory, and imaging characteristics were recorded. BAFF rs9514827, rs1041569, and rs9514828 polymorphisms were assessed by RFLP-PCR in DNA samples extracted from whole peripheral blood. The BAFF rs1041569 TT genotype along with the CTT and TTC haplotypes were associated with significantly increased risk for MS development in female MS patients compared to healthy female counterparts. These findings were not confirmed in males. The rs1041569 BAFF variant together with the CTT and TTC BAFF haplotypes derived from the BAFF rs9514827, rs1041569, and rs9514828 polymorphisms may represent novel genetic contributors to the development of MS in females.
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Affiliation(s)
- Charalampos Skarlis
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens (NKUA), M. Asias 75, 11527, Athens, Greece
| | - Vassilis Papadopoulos
- First Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sylvia Raftopoulou
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens (NKUA), M. Asias 75, 11527, Athens, Greece
| | - Clio P Mavragani
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens (NKUA), M. Asias 75, 11527, Athens, Greece; Joint Academic Rheumatology Program, NKUA, Greece.
| | - Maria-Eleftheria Evangelopoulos
- First Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
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13
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Bergien SO, Skovgaard L, Kristiansen M. Unfolding biographies-a participatory narrative study on how older adults with multiple sclerosis make sense of and manage their everyday lives. BMC Geriatr 2023; 23:794. [PMID: 38041101 PMCID: PMC10693063 DOI: 10.1186/s12877-023-04504-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Today, public health research on later life, including the literature on aging with multiple sclerosis, is often centered on aging as a biological phenomenon. By applying a participatory narrative approach, this study conveys how studying biographical aging provides important insights into the elements of aging that people find relevant and meaningful. Based on narratives told by older adults living with multiple sclerosis, we explore how sensemaking unfolds and shapes the management of later life with a chronic and progressive disease. METHODS Twenty-four older adults (aged 65 years or older) living with multiple sclerosis in Denmark were engaged in taking photographs of their everyday lives and unfold the stories framed in their photographs in subsequent narrative interviews. Interview data were analyzed using a thematic narrative analysis. Aligned with the narrative approach, the findings of the analysis are presented using five cases chosen because they provide insight into the general patterns and themes identified across the narratives of the 24 participants. RESULTS Based on their photographs, the participants narrated stories centered around what they perceived as meaningful activities and social identity when aging with a progressive disease. Three themes emerged from the analysis in relation to how participants made sense of and managed aging with multiple sclerosis: 1) a life woven by non-detachable life experiences, 2) envisioning the future and 3) challenging life circumstances. CONCLUSION The findings of the study highlight that aging with multiple sclerosis is not only a biological phenomenon but also something nested in people's biographies. How people make sense of and manage their everyday lives is shaped by strategies from all parts of their lives-past, present and future. This understanding of later life with multiple sclerosis may enhance the care offered to older adults living with multiple sclerosis if greater emphasis is placed on the exploration of their narratives and the things they find meaningful.
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Affiliation(s)
- Sofie Olsgaard Bergien
- The Danish Multiple Sclerosis Society, Poul Bundgaards Vej 1, Valby, 2500, Denmark.
- Department of Public Health, University of Copenhagen, Oester Farimagsgade 5A, Copenhagen K, Copenhagen, 1014, Denmark.
| | - Lasse Skovgaard
- The Danish Multiple Sclerosis Society, Poul Bundgaards Vej 1, Valby, 2500, Denmark
| | - Maria Kristiansen
- Department of Public Health, University of Copenhagen, Oester Farimagsgade 5A, Copenhagen K, Copenhagen, 1014, Denmark
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Jacober SLS, Disanto G, Sacco R, Meng D, Mallucci G, Candrian U, Semini S, Tiberti M, Gobbi C, Zecca C. Interplay between age and disease-modifying treatments in influencing infection risk in multiple sclerosis. Mult Scler 2023; 29:1765-1775. [PMID: 37786964 DOI: 10.1177/13524585231199820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND Disease-modifying treatments (DMTs) can increase the risk of infections in multiple sclerosis (MS). Aged individuals are usually excluded from clinical trials, and there is uncertainty regarding safety of immunosuppressive DMTs in these patients. OBJECTIVE To investigate the association of DMTs, ageing and other clinical variables with risk of infections in MS patients. METHODS Prospective single-centre observational study collecting information on occurrence, type and grade of infections in patients followed at the MS centre, Lugano (Switzerland). Associations with infection risk were tested using multivariable Poisson and Cox regressions. RESULTS A total of 503 patients were included (injectables/untreated, n = 127; orals, n = 139; monoclonal antibodies (MAB), n = 237) and 326 infections recorded over 12.6 (11.6-14.0) months. As compared to injectable DMTs/no treatment, MAB and oral DMTs were positively associated with infection incidence (IRR = 2.32, 95% confidence interval (CI) = 1.39-3.89, p = 0.001; IRR = 2.04, 95% CI = 1.19-3.49, p = 0.009, respectively). After excluding COVID-19, the effect of MAB was stronger among patients <50 years (IRR = 5.90, 95% CI = 2.80-12.45, p < 0.001) than >50 years (IRR = 1.95, 95% CI = 0.91-4.15, p = 0.084). Higher disability and male sex were the only variables associated with severe infections. CONCLUSION Treatment with MAB and oral DMTs is associated with higher incidence of infections, with a stronger effect in young MS patients. Disability appears the main predictor of severe infections regardless of treatment.
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Affiliation(s)
- Sarah Lena Susanna Jacober
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Giulio Disanto
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Rosaria Sacco
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Delania Meng
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Giulia Mallucci
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Ursula Candrian
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Sebastiano Semini
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Massimiliano Tiberti
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Claudio Gobbi
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Chiara Zecca
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Bergien SO, Siersma VD, Kristiansen M, Skovgaard L. Social relations and leisure activities as predictors of wellbeing among older adults with multiple sclerosis: A cross-sectional survey study in Denmark. Mult Scler Relat Disord 2023; 77:104878. [PMID: 37429098 DOI: 10.1016/j.msard.2023.104878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Due to the growing number of people aging with multiple sclerosis (MS), there has been a call for rehabilitation specially targeted older adults with MS in order to support them in better wellbeing, despite physical and cognitive impairment. However, the existing research within the area of rehabilitation has primarily focused on the physical and psychological aspects of aging with MS, omitting the social element. OBJECTIVE This study aims to examine how social relations and engagement in leisure activities predict wellbeing among older adults with MS living in Denmark. Furthermore, the study aims to identify which sociodemographic and health-related factors are the most important in predicting whether older adults with MS face challenges in participating in leisure activities and experiencing different kinds of social relations. METHOD A cross-sectional survey was designed to measure social relations, wellbeing, and engagement in leisure activities among older adults with MS. Of the 4,329 people over 65 years diagnosed with MS in Denmark in 2022, 2,574 (59.46%) were invited to participated in the study, and 1,107 (43.03%) ended up answering the survey. Linear and logistic regression analyses and dominance analyses were conducted to examine the associations between wellbeing, leisure activities, social relations, sociodemographic and health-related factors. RESULTS The results of the study show that perceived emotional social support (mean difference 8.69, 95% CI 5.23; 12.14) and perceived instrumental social support (mean difference 4.15, 95% CI 0.95; 7.35), were associated with better wellbeing among older adults with MS. Perceived strained social relations (mean difference -7.95, 95% CI -10.66; -5.26) were on the contrary associated with lower levels of wellbeing. Strained social relations were the most important predictors of wellbeing accounting for 59% of the predicted variance. Experiencing social emotional support from friends, coworkers, or neighbors (39% of the predicted variance), experiencing instrumental social support from children or children in law (43% of the predicted variance), and experiencing strained social relations with partner (48% of the predicted variance) constituted he most important predictor of wellbeing. Engagement in five out of fourteen leisure activities were associated with better wellbeing among the participants. The leisure activities there was found to be the most important predictor of wellbeing represented both social (37% of the predicted variance), physical (18% of the predicted variance), and creative elements (13% of the predicted variance). Finally, cohabitation was found to be the most important predictor of having perceived emotional social support (59% of the predicted variance), instrumental social support (78.9% of the predicted variance) and strained social relations (18.8% of the predicted variance) and mobility was found to be the most important predictor of challenges in participating in leisure activities (81.8% of the predicted variance). CONCLUSION The findings of the study highlight that rehabilitation targeting older adults with MS should focus on both physical, psychological, and social elements of peoples' everyday life. Further, the results indicate that future rehabilitation focusing on social elements of aging with MS should take into account health and sociodemographic characteristics such as cohabitation, mobility, age, and sex, as these potentially relate to participation in leisure activities as well as social relations among older adults.
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Affiliation(s)
- Sofie Olsgaard Bergien
- The Danish Multiple Sclerosis Society, Valby, Denmark; Center for Healthy Aging, Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Volkert Dirk Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Center for Healthy Aging, Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Lorefice L, Fenu G, Fronza M, Murgia F, Frau J, Coghe G, Barracciu MA, Atzori L, Angioni S, Cocco E. Menopausal transition in multiple sclerosis: relationship with disease activity and brain volume measurements. Front Neurol 2023; 14:1251667. [PMID: 37602270 PMCID: PMC10434500 DOI: 10.3389/fneur.2023.1251667] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Background Recent evidence has shown a significant association between menopause and multiple sclerosis (MS) progression. This study investigated the possible role of menopause in influencing MS from clinical and neuroradiological perspectives. Notably, the possible association between menopause and brain atrophy has been evaluated. Materials and methods This study included women with MS whose ages ranged from 45 to 55 years. Demographic and clinical characteristics were collected, and the reproductive phase was defined as non-menopausal or menopausal based on the final menstrual period. Thus, MS activity over the past year was reported as the annualised relapse rate (ARR), and MRI activity (defined as new T2 lesions and/or the presence of gadolinium-enhancing lesions at the last MRI assessment in comparison with the MRI performed within the previous 12 months) were compared between non-menopausal women (non-MW) and menopausal women (MW). Volume measurements of the whole brain (WB), white matter (WM), grey matter (GM), and cortical GM were estimated using the SIENAX software, and the possible relationship with menopausal status was assessed by regression analysis. Results The study included 147 women with MS. Eighty-four (57.1%) were MW, with a mean age of 48.5 ± 4.3 years at menopause onset and a mean duration of menopause of 4.1 ± 1.1 years. When compared for ARR, MW reported a lower rate than the non-MW (ARR of 0.29 ± 0.4 vs. 0.52 ± 0.5; p < 0.01). MRI activity was observed in 13.1% of MW and 20.6% of non-MW (p = 0.03). Lower cortical GM volumes (578.1 ± 40.4 mL in MW vs. 596.9 ± 35.8 mL in non-MW; p < 0.01) have also been reported. Finally, multivariate analysis showed a significant association of lower ARR (p = 0.001) and cortical GM volume (p = 0.002) with menopausal status after correction for chronological age and other variables. Discussion Menopause may be an adverse prognostic factor of MS. Our preliminary results suggest that menopause may facilitate cortical GM atrophy, probably due to a decline in the neuroprotective effects of estrogen, with negative effects on MS evolution.
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Affiliation(s)
- Lorena Lorefice
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, University of Cagliari, Cagliari, Italy
| | - Giuseppe Fenu
- Department of Neurosciences, ARNAS Brotzu, Cagliari, Italy
| | - Marzia Fronza
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, University of Cagliari, Cagliari, Italy
| | - Federica Murgia
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Jessica Frau
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, University of Cagliari, Cagliari, Italy
| | - Giancarlo Coghe
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, University of Cagliari, Cagliari, Italy
| | | | - Luigi Atzori
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, University of Cagliari, Cagliari, Italy
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17
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Yang Y, Huang L. Neurological Disorders following COVID-19 Vaccination. Vaccines (Basel) 2023; 11:1114. [PMID: 37376503 DOI: 10.3390/vaccines11061114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Nowadays, people all over the world have been receiving different types of coronavirus disease 2019 (COVID-19) vaccines. While their effectiveness has been well recognized, various post-vaccination disorders are not fully understood. In this review, we discuss neurological disorders related to vascular, immune, infectious, and functional factors following COVID-19 vaccination, and attempt to provide neuroscientists, psychiatrists, and vaccination staff with a reference for the diagnosis and treatment of these diseases. These disorders may present as a recurrence of previous neurological disorders or new-onset diseases. Their incidence rate, host and vaccine characteristics, clinical manifestations, treatment, and prognosis differ significantly. The pathogenesis of many of them remains unclear, and further studies are needed to provide more evidence. The incidence rate of severe neurological disorders is relatively low, most of which are reversible or treatable. Therefore, the benefits of vaccination outweigh the risk of COVID-19 infection, especially among fragile populations.
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Affiliation(s)
- Ying Yang
- Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Lisu Huang
- Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
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18
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Wandall-Holm MF, Holm RP, Pontieri L, Sellebjerg F, Magyari M. Socioeconomic status of the elderly MS population compared to the general population: a nationwide Danish matched cross-sectional study. Front Neurol 2023; 14:1214897. [PMID: 37384281 PMCID: PMC10296197 DOI: 10.3389/fneur.2023.1214897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/18/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction/objectives Multiple sclerosis (MS) leads to physical and cognitive disability, which in turn impacts the socioeconomic status of the individual. The altered socioeconomic trajectory combined with the critical role of aging in MS progression could potentially lead to pronounced differences between MS patients and the general population. Few nations have the ability to connect long-term clinical and socioeconomic data at the individual level, and Denmark's robust population-based registries offer unique insights. This study aimed to examine the socioeconomic aspects of elderly Danish MS patients in comparison to matched controls from the general population. Methods A nationwide population-based study in Denmark was conducted, comprising all living MS patients aged 50 years or older as of 1 January 2021. Patients were matched 1:10 based on sex, age, ethnicity, and residence with a 25% sample of the total Danish population. Demographic and clinical information was sourced from the Danish Multiple Sclerosis Registry, while socioeconomic data were derived from national population-based registries containing details on education, employment, social services, and household characteristics. Univariate comparisons between MS patients and matched controls were then carried out. Results The study included 8,215 MS patients and 82,150 matched individuals, with a mean age of 63.4 years (SD: 8.9) and a 2:1 female-to-male ratio. For those aged 50-64 years, MS patients demonstrated lower educational attainment (high education: 28.3 vs. 34.4%, P < 0.001) and fewer received income from employment (46.0 vs. 78.9%, P < 0.001), and working individuals had a lower annual income (48,500 vs. 53,500€, P < 0.001) in comparison to the controls. Additionally, MS patients within this age group were more likely to receive publicly funded practical assistance (14.3 vs. 1.6%, P < 0.001) and personal care (10.5 vs. 0.8%, P < 0.001). Across the entire population, MS patients were more likely to live alone (38.7 vs. 33.8%, P < 0.001) and less likely to have one or more children (84.2 vs. 87.0%, P < 0.001). Conclusion MS presents significant socioeconomic challenges among the elderly population, such as unemployment, reduced income, and increased dependence on social care. These findings underscore the pervasive impact of MS on an individual's life course, extending beyond the clinical symptoms of cognitive and physical impairment.
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Affiliation(s)
- Malthe Faurschou Wandall-Holm
- Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital – Rigshospitalet, Glostrup, Denmark
| | - Rolf Pringler Holm
- Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital – Rigshospitalet, Glostrup, Denmark
| | - Luigi Pontieri
- Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital – Rigshospitalet, Glostrup, Denmark
| | - Finn Sellebjerg
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital – Rigshospitalet, Glostrup, Denmark
| | - Melinda Magyari
- Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital – Rigshospitalet, Glostrup, Denmark
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital – Rigshospitalet, Glostrup, Denmark
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19
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Capasso N, Virgilio E, Covelli A, Giovannini B, Foschi M, Montini F, Nasello M, Nilo A, Prestipino E, Schirò G, Sperandei S, Clerico M, Lanzillo R. Aging in multiple sclerosis: from childhood to old age, etiopathogenesis, and unmet needs: a narrative review. Front Neurol 2023; 14:1207617. [PMID: 37332984 PMCID: PMC10272733 DOI: 10.3389/fneur.2023.1207617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
Multiple sclerosis (MS) primarily affects adult females. However, in the last decades, rising incidence and prevalence have been observed for demographic extremes, such as pediatric-onset MS (POMS; occurring before 18 years of age) and late-onset MS (corresponding to an onset above 50 years). These categories show peculiar clinical-pathogenetic characteristics, aging processes and disease courses, therapeutic options, and unmet needs. Nonetheless, several open questions are still pending. POMS patients display an important contribution of multiple genetic and environmental factors such as EBV, while in LOMS, hormonal changes and pollution may represent disease triggers. In both categories, immunosenescence emerges as a pathogenic driver of the disease, particularly for LOMS. In both populations, patient and caregiver engagement are essential from the diagnosis communication to early treatment of disease-modifying therapy (DMTs), which in the elderly population appears more complex and less proven in terms of efficacy and safety. Digital technologies (e.g., exergames and e-training) have recently emerged with promising results, particularly in treating and following motor and cognitive deficits. However, this offer seems more feasible for POMS, being LOMS less familiar with digital technology. In this narrative review, we discuss how the aging process influences the pathogenesis, disease course, and therapeutic options of both POMS and LOMS. Finally, we evaluate the impact of new digital communication tools, which greatly interest the current and future management of POMS and LOMS patients.
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Affiliation(s)
- Nicola Capasso
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Naples, Italy
| | - Eleonora Virgilio
- Neurology Unit, Department of Translational Medicine, AOU Maggiore della Carità Novara, University of Eastern Piedmont, Novara, Italy
| | - Antonio Covelli
- Department of Neurology, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Beatrice Giovannini
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Matteo Foschi
- Department of Neuroscience, MS Center, S. Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, L’Aquila, Italy
| | - Federico Montini
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Nasello
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Annacarmen Nilo
- Clinical Neurology Unit, Department of Head, Neck and Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Elio Prestipino
- UOSC Neuro-Stroke Unit, AORN Antonio Cardarelli, Naples, Italy
| | - Giuseppe Schirò
- Section of Neurology, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Silvia Sperandei
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marinella Clerico
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Roberta Lanzillo
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Naples, Italy
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20
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Samara A, Cantoni C, Piccio L, Cross AH, Chahin S. Obesity, gut microbiota, and multiple sclerosis: Unraveling the connection. Mult Scler Relat Disord 2023; 76:104768. [PMID: 37269641 DOI: 10.1016/j.msard.2023.104768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/05/2023]
Abstract
Obesity is associated with chronic mild-grade systemic inflammation and neuroinflammation. Obesity in early childhood and adolescence is also a significant risk factor for multiple sclerosis (MS) development. However, the underlying mechanisms that explain the link between obesity and MS development are not fully explored. An increasing number of studies call attention to the importance of gut microbiota as a leading environmental risk factor mediating inflammatory central nervous system demyelination, particularly in MS. Obesity and high-calorie diet are also associated with disturbances in gut microbiota. Therefore, gut microbiota alteration is a plausible connection between obesity and the increased risk of MS development. A greater understanding of this connection could provide additional therapeutic opportunities, like dietary interventions, microbiota-derived products, and exogenous antibiotics and probiotics. This review summarizes the current evidence regarding the relationships between MS, obesity, and gut microbiota. We discuss gut microbiota as a potential link between obesity and increased risk for MS. Additional experimental studies and controlled clinical trials targeting gut microbiota are warranted to unravel the possible causal relationship between obesity and increased risk of MS.
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Affiliation(s)
- Amjad Samara
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - Claudia Cantoni
- Department of Translational Neuroscience, Barrow Neurological Institute, Phoenix, AZ, 85013, United States
| | - Laura Piccio
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States; Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Anne H Cross
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - Salim Chahin
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States.
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21
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Rostgaard K, Nielsen NM, Melbye M, Frisch M, Hjalgrim H. Siblings reduce multiple sclerosis risk by preventing delayed primary Epstein-Barr virus infection. Brain 2023; 146:1993-2002. [PMID: 36317463 DOI: 10.1093/brain/awac401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 09/22/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022] Open
Abstract
Epstein-Barr virus infection, and perhaps almost exclusively delayed Epstein-Barr virus infection, seems to be a prerequisite for the development of multiple sclerosis. Siblings provide protection against infectious mononucleosis by occasionally preventing delayed primary Epstein-Barr virus infection, with its associated high risk of infectious mononucleosis. Each additional sibling provides further protection according to the age difference between the index child and the sibling. The closer the siblings are in age, the higher the protection, with younger siblings being more protective against infectious mononucleosis than older siblings. If the hypothesis that delayed Epstein-Barr virus infection is necessary for the development of multiple sclerosis is true, then the relative risk of multiple sclerosis as a function of sibship constellation should mirror the relative risk of infectious mononucleosis as a function of sibship constellation. Such an indirect hypothesis test is necessitated by the fact that age at primary Epstein-Barr virus infection is unknown for practically all people who have not experienced infectious mononucleosis. In this retrospective cohort study using nationwide registers, we followed all Danes born during the period 1971-2018 (n = 2 576 011) from 1977 to 2018 for hospital contacts with an infectious mononucleosis diagnosis (n = 23 905) or a multiple sclerosis diagnosis (n = 4442), defining two different end points. Relative risks (hazard ratios) of each end point as a function of sibship constellation were obtained from stratified Cox regression analyses. The hazard ratios of interest for infectious mononucleosis and multiple sclerosis could be assumed to be identical (test for homogeneity P = 0.19), implying that having siblings, especially of younger age, may protect a person against multiple sclerosis through early exposure to the Epstein-Barr virus. Maximum protection per sibling was obtained by having a 0-2 years younger sibling, corresponding to a hazard ratio of 0.80, with a 95% confidence interval of 0.76-0.85. The corresponding hazard ratio from having an (0-2 years) older sibling was 0.91 (0.86-0.96). Our results suggest that it may be possible essentially to eradicate multiple sclerosis using an Epstein-Barr virus vaccine administered before the teenage years. Getting there would require both successful replication of our study findings and, if so, elucidation of why early Epstein-Barr virus infection does not usually trigger the immune mechanisms responsible for the association between delayed Epstein-Barr virus infection and multiple sclerosis risk.
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Affiliation(s)
- Klaus Rostgaard
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Nete Munk Nielsen
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Mads Melbye
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Center for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Morten Frisch
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Henrik Hjalgrim
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
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22
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Houzen H, Kano T, Kondo K, Takahashi T, Niino M. The prevalence and incidence of multiple sclerosis over the past 20 years in northern Japan. Mult Scler Relat Disord 2023; 73:104696. [PMID: 37028125 DOI: 10.1016/j.msard.2023.104696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/27/2023] [Accepted: 04/01/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVES The prevalence of multiple sclerosis (MS) in East Asia is thought to be lower than in Western countries. Globally, there is a trend of increasing MS prevalence. We investigated the changes in the prevalence and clinical phenotype of MS in the Tokachi province of Hokkaido in northern Japan, from 2001 to 2021. METHODS Data processing sheets were sent to all related institutions inside and outside the Tokachi area of Hokkaido island in Japan and were collected from April to May 2021. The prevalence according to the Poser's diagnostic criteria for MS was determined on March 31, 2021. RESULTS In 2021, the crude MS prevalence in northern Japan was 22.4/100,000 (95% confidence interval, 17.6-28.0). The prevalences of MS standardized by the Japanese national population in 2001, 2006, 2011, 2016, and 2021 were 6.9, 11.5, 15.3, 18.5, and 23.3, respectively. The female/male ratio was 4.0 in 2021, increased from 2.6 in 2001. We checked the prevalence using the 2017 revised McDonald criteria, and found only additional male patient who had not fulfilled Poser's criteria. The age- and sex-adjusted incidence of MS per 100,000 individuals increased from 0.09 in 1980-1984 to 0.99 in 2005-2009; since then, it has remained stable. The proportions of primary-progressive, relapsing-remitting, and secondary-progressive MS types in 2021 were 3%, 82%, and 15%, respectively. CONCLUSION Our results demonstrated a consistent increase in the prevalence of MS among the northern Japanese over 20 years, particularly in females, and consistently lower rates of progressive MS in northern Japan than elsewhere in the world.
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23
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Bjornevik K, Münz C, Cohen JI, Ascherio A. Epstein-Barr virus as a leading cause of multiple sclerosis: mechanisms and implications. Nat Rev Neurol 2023; 19:160-171. [PMID: 36759741 DOI: 10.1038/s41582-023-00775-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 02/11/2023]
Abstract
Epidemiological studies have provided compelling evidence that multiple sclerosis (MS) is a rare complication of infection with the Epstein-Barr virus (EBV), a herpesvirus that infects more than 90% of the global population. This link was long suspected because the risk of MS increases markedly after infectious mononucleosis (symptomatic primary EBV infection) and with high titres of antibodies to specific EBV antigens. However, it was not until 2022 that a longitudinal study demonstrated that MS risk is minimal in individuals who are not infected with EBV and that it increases over 30-fold following EBV infection. Over the past few years, a number of studies have provided clues on the underlying mechanisms, which might help us to develop more targeted treatments for MS. In this Review, we discuss the evidence linking EBV to the development of MS and the mechanisms by which the virus is thought to cause the disease. Furthermore, we discuss implications for the treatment and prevention of MS, including the use of antivirals and vaccines.
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Affiliation(s)
- Kjetil Bjornevik
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christian Münz
- Viral Immunobiology, Institute of Experimental Immunology, University of Zürich, Zürich, Switzerland
| | - Jeffrey I Cohen
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Alberto Ascherio
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
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24
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Moghtaderi A, Shahidi-Pourakbari M, Izadi S, Khosravi A, Hashemzehi Z. Ongoing increase in incidence and prevalence of multiple sclerosis in south-eastern Iran: A three decade study. Mult Scler Relat Disord 2023; 71:104557. [PMID: 36857854 DOI: 10.1016/j.msard.2023.104557] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 01/09/2023] [Accepted: 02/09/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Prevalence of multiple sclerosis has been increased during the last decades throughout the world. Epidemiological studies could improve our understanding relating to its intrinsic and extrinsic causes. OBJECTIVES The current study has been conducted to determine the epidemiological features of MS in south-eastern Iran which is a semi-tropical area with different ethnicities. METHODS This longitudinal descriptive study was carried out in south-eastern Iran, based on information of MS patients registered at Zahedan University of Medical Sciences database from 1990 to 2020. RESULTS A total of 1045 cases were enrolled into the study. The age-standardized prevalence ratio of MS increased to 42.2/100,000 population by 2020. These figures showed increasing trends both in females and males and reached to 61.5 and 22.6 per 100,000 population, respectively by the year 2020. Likewise, the total incidence rate grew to its maximum amount of 4.5 in 2015. Female incidence also revealed an upward trend and peaked in 2016 to 6.4 while male incidence rate reached at its highest level of 1.8 in 2009. CONCLUSION MS prevalence ratios and incidence rates in south-eastern Iran have been increasing steadily, especially in women during the last three decades. The south-eastern part of Iran should be considered a high-risk region.
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Affiliation(s)
- Ali Moghtaderi
- Department of Neurology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
| | | | - Shahrokh Izadi
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Khosravi
- Department of Neurology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zabihollah Hashemzehi
- Department of Neurology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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25
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Lorefice L, D’Alterio MN, Firinu D, Fenu G, Cocco E. Impact of Menopause in Patients with Multiple Sclerosis: Current Perspectives. Int J Womens Health 2023; 15:103-109. [PMID: 36721498 PMCID: PMC9884461 DOI: 10.2147/ijwh.s334719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
Given the aging population, with a peak age-specific prevalence that is shifting beyond the age of 50, several women currently living with MS are very close to menopause. Menopause is usually characterized by several specific symptoms with adverse impacts on different aspects of a woman's quality of life, such as fatigue, and cognitive, mood and bladder disorders, which overlap with symptoms of MS. Generally, after this biological transition, women with MS appear to be subject to less inflammatory activity. However, several studies have reported an increase of disability accumulation after menopause, suggesting that it is a turning point to a more progressive phase of the disease. This may be attributable to the hormonal and immunological changes associated with menopause, with several effects on neuroinflammation and neurodegeneration increasing due to the immunosenescence of aging. This review summarizes the hormonal and immunological changes associated with menopause, detailing the effects on MS symptoms, outcomes, and the aging process. Furthermore, possible interventions to improve patients' quality of life are evaluated. In fact, it is increasingly necessary to improve the global management of MS women, as well as their lives, at this multifaceted turning point.
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Affiliation(s)
- Lorena Lorefice
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy,Correspondence: Lorena Lorefice, Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, via Is Guadazzonis 2, Cagliari, 09126, Italy, Email
| | - Maurizio Nicola D’Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Davide Firinu
- Clinical Immunology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giuseppe Fenu
- Department of Neurosciences, ARNAS Brotzu, Cagliari, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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26
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Qian Z, Li Y, Guan Z, Guo P, Zheng K, Du Y, Yin S, Chen B, Wang H, Jiang J, Qiu K, Zhang M. Global, regional, and national burden of multiple sclerosis from 1990 to 2019: Findings of global burden of disease study 2019. Front Public Health 2023; 11:1073278. [PMID: 36875359 PMCID: PMC9982151 DOI: 10.3389/fpubh.2023.1073278] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/16/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND The global rising prevalence and incidence of multiple sclerosis (MS) has been reported during the past decades. However, details regarding the evolution of MS burden have not been fully studied. This study aimed to investigate the global, regional, and national burden and temporal trends in MS incidence, deaths, and disability-adjusted life years (DALYs) from 1990 to 2019 using the age-period-cohort analysis. METHODS We performed a secondary comprehensive analysis of incidence, deaths, and DALYs of MS by calculating the estimated annual percentage change from 1990 to 2019 obtained from the Global Burden of Disease (GBD) 2019 study. The independent age, period, and birth cohort effects were evaluated by an age-period-cohort model. RESULTS In 2019, there were 59,345 incident MS cases and 22,439 MS deaths worldwide. The global number of incidences, deaths, and DALYs of MS followed an upward trend, whereas the age-standardized rates (ASR) slightly declined from 1990 to 2019. High socio-demographic index (SDI) regions had the highest ASR of incidences, deaths, and DALYs in 2019, while the rate of deaths and DALYs in medium SDI regions are the lowest. Six regions which include high-income North America, Western Europe, Australasia, Central Europe, and Eastern Europe had higher ASR of incidences, deaths, and DALYs than other regions in 2019. The age effect showed that the relative risks (RRs) of incidence and DALYs reached the peak at ages 30-39 and 50-59, respectively. The period effect showed that the RRs of deaths and DALYs increased with the period. The cohort effect showed that the later cohort has lower RRs of deaths and DALYs than the early cohort. CONCLUSION The global cases of incidence, deaths, and DALYs of MS have all increased, whereas ASR has declined, with different trends in different regions. High SDI regions such as European countries have a substantial burden of MS. There are significant age effects for incidence, deaths, and DALYs of MS globally, and period effects and cohort effects for deaths and DALYs.
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Affiliation(s)
- Zhen Qian
- Department of Ophthalmology, Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, Shantou, China
| | - Yuancun Li
- Department of Ophthalmology, Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, Shantou, China
| | - Zhiqiang Guan
- Department of Ophthalmology, Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, Shantou, China
| | - Pi Guo
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
| | - Ke Zheng
- Department of Ophthalmology, Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, Shantou, China
| | - Yali Du
- Department of Ophthalmology, Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, Shantou, China
| | - Shengjie Yin
- Department of Ophthalmology, Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, Shantou, China
| | - Binyao Chen
- Department of Ophthalmology, Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, Shantou, China
| | - Hongxi Wang
- Department of Ophthalmology, Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, Shantou, China
| | - Jiao Jiang
- Department of Ophthalmology, Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, Shantou, China
| | - Kunliang Qiu
- Department of Ophthalmology, Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, Shantou, China
- *Correspondence: Kunliang Qiu ✉
| | - Mingzhi Zhang
- Department of Ophthalmology, Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, Shantou, China
- Mingzhi Zhang ✉
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Michelis D, Brunetti N, Solaro C, Mancardi GL, Uccelli A, Inglese M, Laroni A. Aging with multiple sclerosis: Clinical characterization of an elderly population, a cross-sectional study. Mult Scler Relat Disord 2023; 69:104464. [PMID: 36521384 DOI: 10.1016/j.msard.2022.104464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/07/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Daniele Michelis
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Nicole Brunetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Claudio Solaro
- Department of Rehabilitation, C.R.R.F. "Mons. L. Novarese", Loc. Trompone, Moncrivello, Italy
| | - Giovanni Luigi Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy.
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Trends in the environmental risks associated with earlier onset in multiple sclerosis. Mult Scler Relat Disord 2022; 68:104250. [PMID: 36544313 DOI: 10.1016/j.msard.2022.104250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/27/2022] [Accepted: 10/16/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Several environmental and lifestyle factors relating to sunlight/vitamin D, body mass index (BMI), and smoking are associated with the risk of developing multiple sclerosis (MS). However, their relation to disease progression, particularly age at symptomatic onset, remains inconsistent, which may be the result of significant changes in human-environment interactions over the last century. This study investigates historical trends in the association between common MS environmental risk factors and age at disease onset. METHODS Using a narrative approach, we evaluated the current literature for published studies assessing the association between vitamin-D, BMI, and tobacco smoking exposures with the risk of early/pediatric-onset MS and direct correlations with age at MS onset using MEDLINE, EMBASE, and Web of Science. Measures were plotted by the average calendar year of disease onset for each cohort to examine trends over time. In total, 25, 9, and 11 articles were identified for vitamin D, BMI, and smoking-related exposures, respectively. RESULTS Higher sun exposure habits and residential solar radiation were associated with older age at onset. On the contrary, two studies observed a negative correlation between age at onset and serum 25-hydroxyvitamin D (25(OH)D) levels. Higher adolescent BMI was generally associated with younger age at onset, although genetic susceptibility for childhood obesity was not significantly associated. Tobacco smoking was associated with later disease onset, despite being a risk factor for MS. Association with age at onset was inflated for more recent studies relating to smoking, while often weaker for serum vitamin D and BMI. CONCLUSION Current findings indicate a likely association between age at onset and environmental risk factors, such as sun exposure, adolescent BMI, and tobacco smoking, in certain populations. However, findings are often inconsistent and assessment of the relationships and potential changes over time require further investigation.
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Romero-Pinel L, Bau L, Matas E, León I, Muñoz-Vendrell A, Arroyo P, Masuet-Aumatell C, Martínez-Yélamos A, Martínez-Yélamos S. The age at onset of relapsing-remitting multiple sclerosis has increased over the last five decades. Mult Scler Relat Disord 2022; 68:104103. [PMID: 36029708 DOI: 10.1016/j.msard.2022.104103] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/11/2022] [Accepted: 08/08/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with relapsing-remitting multiple sclerosis (RRMS) most commonly experience their first symptoms between 20 and 40 years of age. The objective of this study was to investigate how the age at which the first symptoms of RRMS occur has changed over the past decades. METHODS Patients who were followed up in our unit after an initial diagnosis of RRMS using the Poser or McDonald criteria and who experienced their first symptoms between January 1970 and December 2019 were included in the study. The cohort was divided into five groups according to the decade in which the first symptoms appeared. The age at disease onset was compared across decades. Changes in age were also determined after excluding patients with early-onset disease (<18 years of age) and those with late-onset disease (>50 years of age) to avoid bias. RESULTS The cohort included 1,622 patients with RRMS, 67.6% of whom were women. Among them, 5.9% and 4% had early-onset and late-onset disease, respectively. The mean age ± standard deviation at onset was 31.11 ± 9.82 years, with no differences between men and women. The mean ages at onset were 23.79 ± 10.19 years between 1970 and 1979, 27.86 ± 9.22 years between 1980 and 1989, 30.07 ± 9.32 years between 1990 and 1999, 32.12 ± 9.47 between 2000 and 2009, and 34.28 ± 9.83 years between 2010 and 2019. The ages at disease onset were progressively higher in the later decades; this trend was statistically significant (p < 0.001), with a Pearson linear correlation coefficient R of 0.264 and R2 of 0.070 (p < 0.001). The results were similar when analysing men and women separately. We conducted an analysis of 1,460 patients (mean age at onset: 31.10 ± 7.99 years), after excluding patients with early-onset and late-onset disease. In this specific subgroup, the mean ages at disease onset were 28.38 ± 8.17 years between 1970 and 1979, 29.22 ± 7.51 years between 1980 and 1989, 30.06 ± 8.02 years between 1990 and 1999, 31.46 ± 7.77 years between 2000 and 2009, and 33.37 ± 7.97 years between 2010 and 2019. The trend was also statistically significant (p < 0.001), with a Pearson linear correlation coefficient R of 0.193 and R2 of 0.037 (p < 0.001). CONCLUSION Our data showed that the age at RRMS onset has increased over the past decades.
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Affiliation(s)
- Lucía Romero-Pinel
- Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Laura Bau
- Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elisabet Matas
- Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Isabel León
- Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Muñoz-Vendrell
- Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pablo Arroyo
- Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Masuet-Aumatell
- Department of Epidemiology and Preventive Medicine. Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio Martínez-Yélamos
- Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Sergio Martínez-Yélamos
- Multiple Sclerosis Unit, Department of Neurology. Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
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García López FJ, García-Merino A, Alcalde-Cabero E, de Pedro-Cuesta J. Incidence and prevalence of multiple sclerosis in Spain: a systematic review. Neurologia 2022:S2173-5808(22)00177-8. [PMID: 36410655 DOI: 10.1016/j.nrleng.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Greater understanding of the prevalence and incidence of multiple sclerosis in Spain and their temporal trends is necessary to improve the allocation of healthcare resources and to study aetiological factors. METHODS We performed a systematic search of the MedLine database and reviewed the reference lists of the articles gathered. We collected studies reporting prevalence or incidence rates of multiple sclerosis in any geographical location in Spain, with no time limits. In 70% of cases, data were extracted by 2 researchers (FGL and EAC); any discrepancies were resolved by consensus. RESULTS We identified 51 prevalence and 33 incidence studies published between 1968 and 2018. In the adjusted analysis, the number of prevalent cases per 100 000 population increased by 26.6 (95% confidence interval [CI], 21.5-31.8) every 10 years. After adjusting for year and latitude, the number of incident cases per 100 000 population increased by 1.34 (95% CI, 0.98-1.69) every 10 years. We observed a trend toward higher prevalence and incidence rates at higher latitudes. CONCLUSIONS The prevalence of multiple sclerosis in Spain has increased in recent decades, although case ascertainment appears to be incomplete in many studies. Incidence rates have also increased, but this may be due to recent improvements in the detection of new cases.
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Affiliation(s)
- F J García López
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
| | - A García-Merino
- Unidad de Neuroinmunología, Fundación para la Investigación Biomédica Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Majadahonda, Madrid, Spain
| | - E Alcalde-Cabero
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Agencia de Evaluación de Tecnologías Sanitarias, Instituto de Salud Carlos III, Madrid, Spain
| | - J de Pedro-Cuesta
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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Melamed E, Palmer JL, Fonken C. Advantages and limitations of experimental autoimmune encephalomyelitis in breaking down the role of the gut microbiome in multiple sclerosis. Front Mol Neurosci 2022; 15:1019877. [PMID: 36407764 PMCID: PMC9672668 DOI: 10.3389/fnmol.2022.1019877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/11/2022] [Indexed: 08/22/2023] Open
Abstract
Since the first model of experimental autoimmune encephalomyelitis (EAE) was introduced almost a century ago, there has been an ongoing scientific debate about the risks and benefits of using EAE as a model of multiple sclerosis (MS). While there are notable limitations of translating EAE studies directly to human patients, EAE continues to be the most widely used model of MS, and EAE studies have contributed to multiple key breakthroughs in our understanding of MS pathogenesis and discovery of MS therapeutics. In addition, insights from EAE have led to a better understanding of modifiable environmental factors that can influence MS initiation and progression. In this review, we discuss how MS patient and EAE studies compare in our learning about the role of gut microbiome, diet, alcohol, probiotics, antibiotics, and fecal microbiome transplant in neuroinflammation. Ultimately, the combination of rigorous EAE animal studies, novel bioinformatic approaches, use of human cell lines, and implementation of well-powered, age- and sex-matched randomized controlled MS patient trials will be essential for improving MS patient outcomes and developing novel MS therapeutics to prevent and revert MS disease progression.
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Affiliation(s)
- Esther Melamed
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, United States
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Branigan GL, Torrandell-Haro G, Vitali F, Brinton RD, Rodgers K. Age and sex differences on anti-hyperglycemic medication exposure and risk of newly diagnosed multiple sclerosis in propensity score matched type 2 diabetics. Heliyon 2022; 8:e11196. [PMID: 36325137 PMCID: PMC9618986 DOI: 10.1016/j.heliyon.2022.e11196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 06/30/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Background The association between exposure to anti-hyperglycemic medications (A-HgM) for Type 2 Diabetes Mellitus (T2D) treatment and Multiple Sclerosis (MS) in T2D patients is unclear. Methods This retrospective cohort analysis used the Mariner claims database. Patient records were surveyed for a diagnosis of MS starting 12 months after diagnosis of T2D. Patients were required to be actively enrolled in the Mariner claims records for six months prior and at least three years after the diagnosis of T2D without a history of previous neurodegenerative disease. Survival analysis was used to determine the association between A-HgM exposure and diagnosis of MS. A propensity score approach was used to minimize measured and unmeasured selection bias. The analyses were conducted between January 1st and April 28th, 2021. Findings In T2D patients younger than 45, A-HgM exposure was associated with a reduced risk of developing MS (RR: 0.22, 95%CI: 0.17–0.29, p-value <0.001). In contrast, A-HgM exposure in patients older than 45 was associated with an increased risk of MS with women exhibiting greater risk (RR: 1.53, 95%CI: 1.39–1.69, p < 0.001) than men (RR: 1.17, 95%CI: 1.01–1.37, p = 0 · 04). Patients who developed MS had a higher incidence of baseline comorbidities. Mean follow-up was 6.2 years with a standard deviation of 1.8 years. Interpretation In this study, A-HgM exposure in patients with T2D was associated with reduced risk of MS in patients younger than 45 whereas in patients older than 45, exposure to A-HgM was associated with an increased risk of newly diagnosed MS, particularly in women.
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Affiliation(s)
- Gregory L. Branigan
- Center for Innovation in Brain Science; University of Arizona, Tucson, Arizona, USA,Department of Pharmacology; University of Arizona College of Medicine, Tucson, Arizona, USA,MD-PhD Training Program; University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Georgina Torrandell-Haro
- Center for Innovation in Brain Science; University of Arizona, Tucson, Arizona, USA,Department of Pharmacology; University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Francesca Vitali
- Center for Innovation in Brain Science; University of Arizona, Tucson, Arizona, USA,Department of Neurology; University of Arizona College of Medicine, Tucson, Arizona, USA,Center for Biomedical Informatics and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Roberta Diaz Brinton
- Center for Innovation in Brain Science; University of Arizona, Tucson, Arizona, USA,Department of Pharmacology; University of Arizona College of Medicine, Tucson, Arizona, USA,Department of Neurology; University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Kathleen Rodgers
- Center for Innovation in Brain Science; University of Arizona, Tucson, Arizona, USA,Department of Pharmacology; University of Arizona College of Medicine, Tucson, Arizona, USA,Corresponding author.
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Kee R, Naughton M, McDonnell GV, Howell OW, Fitzgerald DC. A Review of Compartmentalised Inflammation and Tertiary Lymphoid Structures in the Pathophysiology of Multiple Sclerosis. Biomedicines 2022; 10:biomedicines10102604. [PMID: 36289863 PMCID: PMC9599335 DOI: 10.3390/biomedicines10102604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic, immune-mediated, demyelinating disease of the central nervous system (CNS). The most common form of MS is a relapsing–remitting disease characterised by acute episodes of demyelination associated with the breakdown of the blood–brain barrier (BBB). In the relapsing–remitting phase there is often relative recovery (remission) from relapses characterised clinically by complete or partial resolution of neurological symptoms. In the later and progressive stages of the disease process, accrual of neurological disability occurs in a pathological process independent of acute episodes of demyelination and is accompanied by a trapped or compartmentalised inflammatory response, most notable in the connective tissue spaces of the vasculature and leptomeninges occurring behind an intact BBB. This review focuses on compartmentalised inflammation in MS and in particular, what we know about meningeal tertiary lymphoid structures (TLS; also called B cell follicles) which are organised clusters of immune cells, associated with more severe and progressive forms of MS. Meningeal inflammation and TLS could represent an important fluid or imaging marker of disease activity, whose therapeutic abrogation might be necessary to stop the most severe outcomes of disease.
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Affiliation(s)
- Rachael Kee
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast BT9 7BL, UK
- Department of Neurology, Royal Victoria Hospital, Belfast BT12 6BA, UK
- Correspondence:
| | - Michelle Naughton
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast BT9 7BL, UK
| | | | - Owain W. Howell
- Institute of Life Sciences, Swansea University, Wales SA2 8QA, UK
| | - Denise C. Fitzgerald
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast BT9 7BL, UK
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Åström ME, Roos PM. Geochemistry of multiple sclerosis in Finland. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 841:156672. [PMID: 35705128 DOI: 10.1016/j.scitotenv.2022.156672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/05/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
Multiple sclerosis (MS) affects some 3 million people around the world and the prevalence is increasing. The MS incidence increases with distance from the equator forming a north-to-south gradient. The cause of this gradient and the cause of MS in general are largely unknown. Sulphide-bearing marine and lake sediments, when exposed to oxygen after drainage, form sulphuric acid resulting in the development of acid sulphate soils. From these soils major neurotoxic metals such as iron, aluminum and manganese and trace metals such as nickel, copper and cadmium are released into the surrounding environment. As these soils are largely used for farming, obvious routes to human metal exposure exist. Here we compare the distribution of acid sulphate soils in Finland to the geographic localisation of MS cases using data from a national acid sulphate soil mapping project and historical MS distribution data. Finland has among the highest MS prevalences in the world and several independent nationwide surveys have shown the highest prevalence in western Finland, stable over time. Acid sulphate soil distribution colocalizes with MS, both on a regional (nationwide) scale and local (proximity to rivers) scale. A toxicokinetic LADME model for MS pathogenesis is presented. We propose that neurotoxic metals leaching from acid sulphate soils contribute to the clustering of MS in Finland.
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Affiliation(s)
- Mats E Åström
- Department of Biology and Environmental Science, Linnaeus University, Kalmar, Sweden
| | - Per M Roos
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Clinical Physiology, St.Göran Hospital, 112 81 Stockholm, Sweden.
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Wimberley T, Horsdal HT, Brikell I, Laursen TM, Astrup A, Fanelli G, Bralten J, Poelmans G, Gils VV, Jansen WJ, Vos SJB, Bertaina-Anglade V, Camacho-Barcia L, Mora-Maltas B, Fernandez-Aranda F, Bonet MB, Salas-Salvadó J, Franke B, Dalsgaard S. Temporally ordered associations between type 2 diabetes and brain disorders - a Danish register-based cohort study. BMC Psychiatry 2022; 22:573. [PMID: 36028833 PMCID: PMC9413891 DOI: 10.1186/s12888-022-04163-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/07/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is linked with several neurodegenerative and psychiatric disorders, either as a comorbid condition or as a risk factor. We aimed to expand the evidence by examining associations with a broad range of brain disorders (psychiatric and neurological disorders, excluding late-onset neurodegenerative disorders), while also accounting for the temporal order of T2DM and these brain disorders. METHODS In a population-based cohort-study of 1,883,198 Danish citizens, born 1955-1984 and followed until end of 2016, we estimated associations between T2DM and 16 brain disorders first diagnosed between childhood and mid-adulthood. We calculated odds ratios (OR) and hazard ratios (HR) with 95% confidence intervals (CI) in temporally ordered analyses (brain disorder diagnosis after T2DM and vice versa), adjusted for sex, age, follow-up, birth year, and parental factors. RESULTS A total of 67,660 (3.6%) of the study population were identified as T2DM cases after age 30 and by a mean age of 45 years (SD of 8 years). T2DM was associated with most psychiatric disorders. Strongest associations were seen with other (i.e. non-anorectic) eating disorders (OR [95% CI]: 2.64 [2.36-2.94]) and schizophrenia spectrum disorder (2.73 [2.63-2.84]). Among neurological disorders especially inflammatory brain diseases (1.73 [1.57-1.91]) and epilepsy (1.67 [1.60-1.75]) were associated with T2DM. Most associations remained in both directions in the temporally ordered analyses. For most psychiatric disorders, associations were strongest in females. CONCLUSIONS T2DM was associated with several psychiatric and neurological disorders, and most associations were consistently found for both temporal order of disorders. This suggests a shared etiology of T2DM and those brain disorders. This study can form the starting point for studies directed at further elucidating potential causal links between disorders and shared biological mechanisms.
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Affiliation(s)
- Theresa Wimberley
- NCRR - National Centre for Register-based Research, Aarhus BSS, Aarhus University, Fuglesangs Allé 26, DK-8210, Aarhus V, Denmark. .,CIRRAU - Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark.
| | - Henriette T. Horsdal
- grid.7048.b0000 0001 1956 2722NCRR - National Centre for Register-based Research, Aarhus BSS, Aarhus University, Fuglesangs Allé 26, DK-8210 Aarhus V, Denmark ,grid.7048.b0000 0001 1956 2722CIRRAU - Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Isabell Brikell
- grid.7048.b0000 0001 1956 2722NCRR - National Centre for Register-based Research, Aarhus BSS, Aarhus University, Fuglesangs Allé 26, DK-8210 Aarhus V, Denmark ,grid.4714.60000 0004 1937 0626Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Thomas M. Laursen
- grid.7048.b0000 0001 1956 2722NCRR - National Centre for Register-based Research, Aarhus BSS, Aarhus University, Fuglesangs Allé 26, DK-8210 Aarhus V, Denmark ,grid.7048.b0000 0001 1956 2722CIRRAU - Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Aske Astrup
- grid.7048.b0000 0001 1956 2722NCRR - National Centre for Register-based Research, Aarhus BSS, Aarhus University, Fuglesangs Allé 26, DK-8210 Aarhus V, Denmark ,grid.7048.b0000 0001 1956 2722CIRRAU - Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Giuseppe Fanelli
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands ,grid.6292.f0000 0004 1757 1758Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Janita Bralten
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Geert Poelmans
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Veerle Van Gils
- grid.5012.60000 0001 0481 6099Department of Psychiatry and Neuropsychology, School for Mental Health and NeuroScience, Alzheimer Centrum Limburg, Maastricht University, Maastricht, Netherlands
| | - Willemijn J. Jansen
- grid.5012.60000 0001 0481 6099Department of Psychiatry and Neuropsychology, School for Mental Health and NeuroScience, Alzheimer Centrum Limburg, Maastricht University, Maastricht, Netherlands
| | - Stephanie J. B. Vos
- grid.5012.60000 0001 0481 6099Department of Psychiatry and Neuropsychology, School for Mental Health and NeuroScience, Alzheimer Centrum Limburg, Maastricht University, Maastricht, Netherlands
| | | | - Lucia Camacho-Barcia
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain ,grid.418284.30000 0004 0427 2257Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Bernat Mora-Maltas
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain ,grid.418284.30000 0004 0427 2257Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Fernando Fernandez-Aranda
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain ,grid.418284.30000 0004 0427 2257Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Mònica B. Bonet
- grid.413448.e0000 0000 9314 1427Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain ,grid.410367.70000 0001 2284 9230Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, Reus, Spain ,grid.411136.00000 0004 1765 529XInstitut d’Investigació Sanitària Pere Virgili (IISPV). Hospital Universitari San Joan de Reus, Reus, Spain
| | - Jordi Salas-Salvadó
- grid.413448.e0000 0000 9314 1427Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain ,grid.411136.00000 0004 1765 529XInstitut d’Investigació Sanitària Pere Virgili (IISPV). Hospital Universitari San Joan de Reus, Reus, Spain ,grid.410367.70000 0001 2284 9230Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Universitat Rovira i Virgili, Reus, Spain
| | - Barbara Franke
- grid.10417.330000 0004 0444 9382Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Psychiatry, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Søren Dalsgaard
- grid.7048.b0000 0001 1956 2722NCRR - National Centre for Register-based Research, Aarhus BSS, Aarhus University, Fuglesangs Allé 26, DK-8210 Aarhus V, Denmark ,grid.452548.a0000 0000 9817 5300iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Aarhus, Denmark ,grid.466916.a0000 0004 0631 4836Center for Child and Adolescent Psychiatry, Mental Health Services of the Capital Region, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Magyari M, Joensen H, Kopp TI, Pontieri L, Koch-Henriksen N. Changes in prognosis of the Danish multiple sclerosis population over time. Mult Scler 2022; 28:2190-2201. [PMID: 35822309 DOI: 10.1177/13524585221110582] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The course of multiple sclerosis (MS) appears to be milder in recent decades. OBJECTIVE To investigate how time from onset to disability milestones and how demographic and clinical characteristics have changed through subsequent onset cohorts of patients with MS. METHODS In the nationwide Danish Multiple Sclerosis Registry, we have registered all 13,562 Danish patients with onset of MS or clinically isolated syndrome from 1996 through 2020. For the analyses of prognosis, we used all cases with relapsing onset (N = 11,669). After stratification into 5-year onset cohorts, we computed the hazard ratios for disability endpoints for all cohorts having at least 10 years of follow-up and the oldest 1996-2000 onset cohort as reference. RESULTS Patients in more recent MS onset cohorts have a shorter diagnostic delay and more of them start disease-modifying treatment within 1 year since diagnosis. The prognosis was better for later onset cohorts. For the 2001-2005 cohort, the hazard ratio for confirmed Expanded Disability Status Scale (EDSS) 4 was 0.85 (95% confidence interval (CI), 0.76-0.95) and for confirmed EDSS 6: 0.76 (95% CI, 0.65-0.88). For the more recent 2006-2010 cohort, the corresponding hazard ratios were 0.70 (95% CI, 0.62-0.79) and 0.60 (95% CI, 0.50-0.71). CONCLUSION We observed a considerable improvement of the prognosis in recent onset cohorts of relapsing-onset MS.
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Affiliation(s)
- Melinda Magyari
- The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark/Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hanna Joensen
- The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tine Iskov Kopp
- The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Luigi Pontieri
- The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nils Koch-Henriksen
- The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark/Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Magyari M, Koch-Henriksen N. Quantitative effect of sex on disease activity and disability accumulation in multiple sclerosis. J Neurol Neurosurg Psychiatry 2022; 93:716-722. [PMID: 35393340 PMCID: PMC9279846 DOI: 10.1136/jnnp-2022-328994] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/16/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To quantify sex differences in activity and severity of multiple sclerosis (MS) and how it depends on disease duration and time since clinical onset. METHODS All Danish citizens with onset of relapsing MS since 1996 who have received disease-modifying therapy have been followed with annual or biannual control visits with mandatory notification of the Danish Multiple Sclerosis Registry. Men and women were compared by the inverse probability of being female. Relapse rates and changes in the Expanded Disability Status Scale (EDSS) scores were analysed with weighted general linear models, and we used weighted Cox regression for HRs between men and women for different EDSS endpoints. RESULTS We included 3028 men and 6619 women. The weighted female:male relapse rate ratio was 1.16 (95% CI: 1.10 to 1.22) but after age 50 years, the difference disappeared. The annualised increase in EDSS was 0.07 in men (95% CI: 0.05 to 0.08) and 0.05 in women (95% CI: 0.04 to 0.06); p=0.017. With women as reference, the HR for reaching EDSS 4 was 1.34 (95% CI: 1.23 to 1.45; p<0.001), and for reaching EDSS 6 it was 1.43 (95% CI: 1.28 to 1.61; p<0.001). The diagnostic delay did not differ significantly between the sexes. CONCLUSION Women have more inflammatory disease activity in terms of relapses than men up to the age of menopause indicating that sex hormones may play a role. Men are more subject to the neurodegenerative component of MS than women, particularly after the age of 45 years.
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Affiliation(s)
- Melinda Magyari
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Copenhagen, Denmark .,The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen, Denmark
| | - Nils Koch-Henriksen
- The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Arrambide G, Espejo C, Carbonell-Mirabent P, Dieli-Crimi R, Rodríguez-Barranco M, Castillo M, Auger C, Cárdenas-Robledo S, Castilló J, Cobo-Calvo Á, Galán I, Midaglia L, Nos C, Otero-Romero S, Río J, Rodríguez-Acevedo B, Ruiz-Ortiz M, Salerno A, Tagliani P, Tur C, Vidal-Jordana A, Zabalza A, Sastre-Garriga J, Rovira A, Comabella M, Hernández-González M, Montalban X, Tintore M. The kappa free light chain index and oligoclonal bands have a similar role in the McDonald criteria. Brain 2022; 145:3931-3942. [PMID: 35727945 DOI: 10.1093/brain/awac220] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/10/2022] [Accepted: 05/29/2022] [Indexed: 11/13/2022] Open
Abstract
Intrathecal production of kappa free light chains (KFLC) occurs in multiple sclerosis and can be measured using the KFLC index. KFLC index values can be determined more easily than oligoclonal bands (OB) detection and seem more sensitive than the immunoglobulin (Ig)G index to diagnose multiple sclerosis. We assessed the value of OB, KFLC index cut-offs 5.9, 6.6, and 10.61, and IgG index to diagnose multiple sclerosis with prospectively acquired data from a clinically isolated syndrome (CIS) inception cohort. We selected patients with sufficient data to determine OB positivity, MRI dissemination in space (DIS) and time (DIT), IgG index, and sufficient quantities of paired CSF and blood samples to determine KFLC indexes (n = 214). We used Kendall´s Tau coefficient to estimate concordance; calculated the number of additional diagnoses when adding each positive index to DIS and positive OB; performed survival analyses for OB and each index with the outcomes second attack and 2017 MRI DIS and DIT; and estimated the diagnostic properties of OB and the different indexes for the abovementioned outcomes at five years. OB were positive in 138 patients (64.5%), KFLC-5.9 in 136 (63.6%), KFLC-6.6 in 135 (63.1%), KFLC-10.61 in 126 (58.9%) and IgG index in 101 (47.2%). The highest concordance was between OB and KFLC-6.6 (τ=0.727) followed by OB and KFLC-5.9 (τ=0.716). Combining DIS plus OB or KFLC-5.9 increased the number of diagnosed patients by 11 (5.1%), with KFLC-6.6 by 10 (4.7%), with KFLC-10.61 by 9 (4.2%), and with IgG index by 3 (1.4%). Patients with positive OB or indexes reached second attack and MRI DIS and DIT faster than patients with negative results (P < 0.0001 except IgG index in second attack: P = 0.016). In multivariable Cox models [aHR (95% CI)], the risk for second attack was very similar between KFLC-5.9 [2.0 (0.9-4.3), P = 0.068] and KFLC-6.6 [2.1 (1.1-4.2), P = 0.035]. The highest risk for MRI DIS and DIT was demonstrated with KFLC-5.9 [4.9 (2.5-9.6), P < 0.0001], followed by KFLC-6.6 [3.4 (1.9-6.3), P < 0.0001]. KFLC-5.9 and KFLC-6.6 had a slightly higher diagnostic accuracy than OB for second attack (70.5, 71.1, and 67.8) and MRI DIS and DIT (85.7, 85.1, and 81.0). KFLC indexes 5.9 and 6.6 performed slightly better than OB to assess multiple sclerosis risk and in terms of diagnostic accuracy. Given the concordance between OB and these indexes, we suggest using DIS plus positive OB or positive KFLC index as a modified criterion to diagnose multiple sclerosis.
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Affiliation(s)
- Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Carmen Espejo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Romina Dieli-Crimi
- Immunology Department, Vall d'Hebron Hospital Universitari. 08035 Barcelona, Spain
| | - Marta Rodríguez-Barranco
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Mireia Castillo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology and Magnetic Resonance Unit. Department of Radiology (IDI). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Simón Cárdenas-Robledo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain.,Department of Neurology, Multiple Sclerosis Center (CEMHUN), Hospital Universitario Nacional de Colombia. 111321 Bogotá, Colombia
| | - Joaquín Castilló
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Ingrid Galán
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Luciana Midaglia
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Carlos Nos
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Susana Otero-Romero
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Jordi Río
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Mariano Ruiz-Ortiz
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain.,Department of Neurology, Hospital Universitario Doce de Octubre, 28041 Madrid, Spain
| | - Annalaura Salerno
- Section of Neuroradiology and Magnetic Resonance Unit. Department of Radiology (IDI). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Paula Tagliani
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Carmen Tur
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Angela Vidal-Jordana
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Ana Zabalza
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology and Magnetic Resonance Unit. Department of Radiology (IDI). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Manuel Hernández-González
- Immunology Department, Vall d'Hebron Hospital Universitari. 08035 Barcelona, Spain.,Diagnostic Immunology Research Group, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Mar Tintore
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
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Hjæresen S, Sejbaek T, Axelsson M, Mortensen SK, Vinsløv-Jensen H, Pihl-Jensen G, Novakova L, Pedersen CB, Halle B, Poulsen FR, Zhang M, Benedikz E, Frederiksen JL, Lycke J, Illes Z, Fex-Svenningsen Å. MIF in the cerebrospinal fluid is decreased during relapsing-remitting while increased in secondary progressive multiple sclerosis. J Neurol Sci 2022; 439:120320. [PMID: 35717879 DOI: 10.1016/j.jns.2022.120320] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Macrophage migration inhibitory factor (MIF) is involved in the function of both the innate and adaptive immune systems and in neuroprotection and has recently been implicated in multiple sclerosis (MS). OBJECTIVES Determination of MIF levels in the cerebrospinal fluid (CSF) of patients with distinct subtypes of MS and the cellular localization of MIF in human brain tissue. METHODS The levels of MIF were investigated in CSF from patients with clinically isolated syndrome (CIS) (n = 26), relapsing-remitting MS (RRMS) (n = 22), secondary progressive MS (SPMS) (n = 19), and healthy controls (HCs) (n = 24), using ELISA. The effect of disease-modifying therapies in the RRMS and SPMS cohorts were examined. Cellular distribution of MIF in the human brain was studied using immunochemistry and the newly available OligoInternode database. RESULTS MIF was significantly decreased in treatment-naïve CIS and RRMS patients compared to HCs but was elevated in SPMS. Interestingly, MIF levels were sex-dependent and significantly higher in women with CIS and RRMS. MIF expression in the human brain was localized to neurons, astrocytes, pericytes, and oligo5 oligodendrocytes but not in microglia. CONCLUSION The finding that MIF was decreased in newly diagnosed CIS and RRMS patients but was high in patients with SPMS may suggest that MIF levels in CSF are regulated by local MIF receptor expression that affects the overall MIF signaling in the brain and may represent a protective mechanism that eventually fails.
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Affiliation(s)
- Simone Hjæresen
- University of Southern Denmark, Department of Molecular Medicine, J.B. Winsløws vej 21, 5000 Odense, Denmark; BRIDGE - Brain Research InterDisciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark.
| | - Tobias Sejbaek
- University of Southern Denmark, Department of Regional Health Research, 5000 Odense, Denmark; University of Copenhagen, Department of Neurology, Southwest Jutland University Hospital, 6700 Esbjerg, Denmark.
| | - Markus Axelsson
- University of Gothenburg, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Sif Kløvedal Mortensen
- University of Southern Denmark, Department of Molecular Medicine, J.B. Winsløws vej 21, 5000 Odense, Denmark.
| | - Helle Vinsløv-Jensen
- University of Southern Denmark, Department of Molecular Medicine, J.B. Winsløws vej 21, 5000 Odense, Denmark
| | - Gorm Pihl-Jensen
- University of Copenhagen, Department of Neurology, Rigshospitalet Glostrup, Copenhagen, Denmark
| | - Lenka Novakova
- University of Gothenburg, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Christian Bonde Pedersen
- Odense University Hospital, Department of Neurosurgery, Clinical Institute and University of Southern Denmark, Denmark; BRIDGE - Brain Research InterDisciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark.
| | - Bo Halle
- Odense University Hospital, Department of Neurosurgery, Clinical Institute and University of Southern Denmark, Denmark; BRIDGE - Brain Research InterDisciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark.
| | - Frantz Rom Poulsen
- Odense University Hospital, Department of Neurosurgery, Clinical Institute and University of Southern Denmark, Denmark; BRIDGE - Brain Research InterDisciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark.
| | - Mengliang Zhang
- University of Southern Denmark, Department of Molecular Medicine, J.B. Winsløws vej 21, 5000 Odense, Denmark; BRIDGE - Brain Research InterDisciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark.
| | - Eirikur Benedikz
- University of Southern Denmark, Faculty of Health Sciences, J.B. Winsløws vej 19., 5000 Odense, Denmark.
| | | | - Jan Lycke
- University of Gothenburg, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Zsolt Illes
- University of Southern Denmark, Department of Molecular Medicine, J.B. Winsløws vej 21, 5000 Odense, Denmark; Odense University Hospital, Department of Neurology, Odense, Denmark; BRIDGE - Brain Research InterDisciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark.
| | - Åsa Fex-Svenningsen
- University of Southern Denmark, Department of Molecular Medicine, J.B. Winsløws vej 21, 5000 Odense, Denmark; BRIDGE - Brain Research InterDisciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark.
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Zarobkiewicz MK, Morawska I, Kowalska W, Halczuk P, Roliński J, Bojarska-Junak AA. PECAM-1 Is Down-Regulated in γδT Cells during Remission, but Up-Regulated in Relapse of Multiple Sclerosis. J Clin Med 2022; 11:jcm11113210. [PMID: 35683597 PMCID: PMC9181399 DOI: 10.3390/jcm11113210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction. PECAM-1 and NKRP1A are both involved in the vascular transmigration of T lymphocytes. Vascular transmigration is a crucial process in multiple sclerosis pathogenesis. Methods and aim. The current paper presents an analysis of PECAM-1 and NKRP1A expression on γδ T cells. Expression of PECAM-1 and NKRP1A on subsets of γδ T cells was performed with flow cytometry. Results. Based on the flow cytometry data, PECAM1 was slightly differentially modulated on γδ T cells—it was up-regulated during relapse, but down-regulated during remission. Moreover, a significant downregulation of CD3 expression was noted on γδ T cells from MS patients, most notably during relapse. Conclusions. This may be a sign of the overall activation of γδ T cells in the course of multiple sclerosis.
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Affiliation(s)
- Michał K. Zarobkiewicz
- Department of Clinical Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (W.K.); (J.R.)
- Correspondence: (M.K.Z.); (A.A.B.-J.)
| | - Izabela Morawska
- Department of Clinical Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (W.K.); (J.R.)
| | - Wioleta Kowalska
- Department of Clinical Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (W.K.); (J.R.)
| | - Paweł Halczuk
- Department of Neurology, Medical University of Lublin, 20-090 Lublin, Poland;
- Department of Histology and Embryology with Experimental Cytology Unit, Medical University of Lublin, 20-080 Lublin, Poland
| | - Jacek Roliński
- Department of Clinical Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (W.K.); (J.R.)
| | - Agnieszka A. Bojarska-Junak
- Department of Clinical Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (W.K.); (J.R.)
- Correspondence: (M.K.Z.); (A.A.B.-J.)
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García López F, García-Merino A, Alcalde-Cabero E, de Pedro-Cuesta J. Incidencia y prevalencia de la esclerosis múltiple en España. Una revisión sistemática. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Simpson-Yap S, Atvars R, Blizzard L, van der Mei I, Taylor BV. Increasing incidence and prevalence of multiple sclerosis in the Greater Hobart cohort of Tasmania, Australia. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-328932. [PMID: 35577508 DOI: 10.1136/jnnp-2022-328932] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/21/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The Greater Hobart region (42.5°S) of Tasmania has consistently had the highest recorded prevalence and incidence rates of multiple sclerosis (MS) in Australia. We reassessed MS epidemiology in 2009-2019 and assessed longitudinal changes over 68 years. METHODS Cases recruited from clinic-based datasets and multiple other data sources. 2019 prevalence and 2009-2019 annual incidence and mortality rates estimated, and differences assessed using Poisson regression. RESULTS 436 MS cases resident on prevalence day were identified, and 130 had symptom onset within 2009-2019. Prevalence 197.1/100 000 (95% CI 179.4 to 216.5; 147.2/100 000 age standardised, 95% CI 126.5 to 171.3), a 36% increase since 2001 and 3.1-fold increase since 1961. 2009-2019 incidence rate=5.9/100 000 person-years, 95% CI 5.0 to 7.0 (6.1/1000 000 age standardised, 95% CI 4.7 to 7.9), a 2.8-fold increase since 1951-1961 and 65% since 2001-2009. 2009-2019 mortality rate=1.5/100 000 person-years, 95% CI 1.1 to 2.2 (0.9/100 000 age standardised, 95% CI 0.4 to 1.7), comparable to 2001-2009 (1.0/100 000) but reduced by 61% from 1951 to 1959 (2.1/100 000). 2001-2009 standardised mortality ratio=1.0 in 2009-2019, decreased from 2.0 in 1971-1979. Female:male prevalence sex ratio was 2.8, comparable to the 2009 value (2.6); incidence sex ratio (2.9) increased from 2001 to 9 (2.1). Comparisons with Newcastle, Australia (latitude=32.5°S) demonstrate a near complete abrogation of the latitudinal gradients for prevalence (ratio=1.0) and incidence (ratio=1.1), largely attributable to changing Hobart demography. CONCLUSIONS Prevalence and incidence of MS continue to increase significantly in Hobart, alongside marked reductions in mortality and increased case longevity. The marked increase in incidence is of particular note and may reflect longstanding changes in MS risk behaviours including changing sun exposure, obesity rates, and smoking behaviours, particularly in females. Falling mortality contributes to increase longevity and prevalence, likely reflecting improved overall MS healthcare and implementation of disease-modifying therapy.
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Affiliation(s)
- Steve Simpson-Yap
- Neuroepidemiology Unit, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Clinical Outcomes Research Unit (CORe), Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- MS Flagship, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Leigh Blizzard
- MS Flagship, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Ingrid van der Mei
- MS Flagship, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Bruce V Taylor
- MS Flagship, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Proteomics in Multiple Sclerosis: The Perspective of the Clinician. Int J Mol Sci 2022; 23:ijms23095162. [PMID: 35563559 PMCID: PMC9100097 DOI: 10.3390/ijms23095162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 02/08/2023] Open
Abstract
Multiple sclerosis (MS) is the inflammatory demyelinating and neurodegenerative disease of the central nervous system (CNS) that affects approximately 2.8 million people worldwide. In the last decade, a new era was heralded in by a new phenotypic classification, a new diagnostic protocol and the first ever therapeutic guideline, making personalized medicine the aim of MS management. However, despite this great evolution, there are still many aspects of the disease that are unknown and need to be further researched. A hallmark of these research are molecular biomarkers that could help in the diagnosis, differential diagnosis, therapy and prognosis of the disease. Proteomics, a rapidly evolving discipline of molecular biology may fulfill this dire need for the discovery of molecular biomarkers. In this review, we aimed to give a comprehensive summary on the utility of proteomics in the field of MS research. We reviewed the published results of the method in case of the pathogenesis of the disease and for biomarkers of diagnosis, differential diagnosis, conversion of disease courses, disease activity, progression and immunological therapy. We found proteomics to be a highly effective emerging tool that has been providing important findings in the research of MS.
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Lane J, Ng HS, Poyser C, Lucas RM, Tremlett H. Multiple sclerosis incidence: A systematic review of change over time by geographical region. Mult Scler Relat Disord 2022; 63:103932. [DOI: 10.1016/j.msard.2022.103932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/25/2022] [Accepted: 05/28/2022] [Indexed: 11/28/2022]
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Prosperini L, Lucchini M, Ruggieri S, Tortorella C, Haggiag S, Mirabella M, Pozzilli C, Gasperini C. Shift of multiple sclerosis onset towards older age. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-329049. [PMID: 35477891 DOI: 10.1136/jnnp-2022-329049] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/01/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore whether age at onset increased over time despite a shortened interval from the initial clinical demyelinating event to the diagnosis of multiple sclerosis (MS), as promoted by updated diagnostic criteria. METHODS This was an independent, multicentre, retrospective study based on data from 4345 patients with relapsing-onset MS attending three tertiary MS Clinics in Italy. After stratifying the year of MS onset into four periods (<1991, 1991-2000, 2001-2010, 2011-2021), we analysed the temporal trends in age at onset and interval from onset to diagnosis; we then explored the female-to-male ratio and onset location across different classes of age at onset. RESULTS We observed an increased mean age at onset, and a shortened mean interval to diagnosis over time (p<0.0001). Accordingly, there were more MS onsets at the older age classes of 40-49, 50-59 and ≥60 years (p<0.0001). In cases with age at onset ≥40 years, we also found an increased female-to-male ratio (p=0.007), more frequent spinal cord (p=0.0004) and less frequent supratentorial onset (p=0.008). CONCLUSION Our study shows a forward shift towards an older age at onset of MS, thus suggesting considerable thought on the place-in-therapy of most currently used disease-modifying treatments, and on the standard of care to an older population.
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Affiliation(s)
- Luca Prosperini
- Dept. of Neurosciences, S. Camillo-Forlanini Hospital, Roma, Italy
| | - Matteo Lucchini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, Roma, Italy
- Università Cattolica del Sacro Cuore, Dip.to di Neuroscienze, Centro di Ricerca per la Sclerosi Multipla (CERSM), Roma, Italy
| | - Serena Ruggieri
- Dept. of Human Neurosciences, Sapienza University, Roma, Italy
- Neuroimmunology Unit, S. Lucia Foundation, Roma, Italy
| | - Carla Tortorella
- Dept. of Neurosciences, S. Camillo-Forlanini Hospital, Roma, Italy
| | - Shalom Haggiag
- Dept. of Neurosciences, S. Camillo-Forlanini Hospital, Roma, Italy
| | - Massimiliano Mirabella
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, Roma, Italy
- Università Cattolica del Sacro Cuore, Dip.to di Neuroscienze, Centro di Ricerca per la Sclerosi Multipla (CERSM), Roma, Italy
| | - Carlo Pozzilli
- Dept. of Human Neurosciences, Sapienza University, Roma, Italy
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Wandall-Holm MF, Andersen MA, Buron MD, Magyari M. Aging With Multiple Sclerosis: Age-Related Factors and Socioeconomic Risks. Front Neurol 2022; 13:818652. [PMID: 35370924 PMCID: PMC8965716 DOI: 10.3389/fneur.2022.818652] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/10/2022] [Indexed: 12/05/2022] Open
Abstract
Background Studies have demonstrated an increasing mean age of the population with multiple sclerosis (MS). The association between increased age and socioeconomic outcomes has been investigated sparsely. Objective The purpose of this study is to describe the demographic and socioeconomic status of the current Danish population of patients with MS according to age and to assess the age-related risks of no income or losing all income from earnings or receiving disability pension. Methods The nationwide population-based Danish Multiple Sclerosis Registry provided data linked with the Danish Income Statistics Register and the Danish Rational Economic Agents Model (DREAM) database. The prevalence of socioeconomic milestones of the current MS population was compared with healthy controls and the risks of reaching socioeconomic milestones were assessed using cause-specific Cox models and cumulative incidence functions compared to healthy controls. Results The current Danish population of patients with MS of working age (18–65 years of age) consists of 11,287 patients, of which 29.3% was older than 55 years. In 2018, 38.0% of all patients and 18.9% of controls had no income from earnings, whereas 30.5% of all patients and 7.7% of controls received disability pension. The risk of losing all income from earnings was higher for patients with MS with a hazard ratio (HR) peaking at of 4.0 (95% CI, 3.8–4.2) for the ages of 45–54 years. The risk of receiving disability pension was much higher for patients with MS peaking at a HR of 22.6 (95% CI, 20.9–24.4) for the ages of 25–34 years. Likewise, the absolute risks of both outcomes were higher for the patients with MS at all ages. Conclusion Danish patients with MS are at a higher risk of losing all income from earnings and at a much higher risk of receiving disability pension compared with healthy controls.
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Affiliation(s)
- Malthe Faurschou Wandall-Holm
- Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital—Rigshospitalet, Glostrup, Denmark
- *Correspondence: Malthe Faurschou Wandall-Holm
| | - Mads Albrecht Andersen
- Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital—Rigshospitalet, Glostrup, Denmark
| | - Mathias Due Buron
- Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital—Rigshospitalet, Glostrup, Denmark
| | - Melinda Magyari
- Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital—Rigshospitalet, Glostrup, Denmark
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital—Rigshospitalet, Glostrup, Denmark
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Ostolaza Ibáñez A, Corroza Laviñeta J, Ayuso Blanco T. Immunosenescence: the role of age in multiple sclerosis. NEUROLOGÍA (ENGLISH EDITION) 2022; 38:284-290. [PMID: 35260362 DOI: 10.1016/j.nrleng.2020.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/11/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The number of elderly people with multiple sclerosis (MS) has increased in line with population ageing. As the immune system presents profound changes over an individual's lifetime, it is important to understand the differences between these patients and younger patients. DEVELOPMENT Immunosenescence, defined as age-related alterations naturally occurring in the immune system, particularly influences tolerance, response, and adverse effects of disease-modifying treatments for MS. Thymic involution is the most noteworthy characteristic of this phenomenon. This process leads to a reduction in the number of virgin T cells. Other effects include an inverted CD4+/CD8+ cell ratio, severe alterations in NK cell functioning, and reduced tissue repair capacity in the brain. CONCLUSIONS The number of older people with MS is increasing due to population ageing, advances in disease-modifying treatments, and improved health and social care of these patients. Ageing of the immune system increases the risk of infections, tumours, and autoimmune diseases in elderly individuals. Furthermore, neurodegeneration is accelerated in patients with MS due to the nervous system's loss of remyelination capacity. Understanding of the changes affecting the immune system in the elderly population is essential to improving the care provided to this ever-growing patient group.
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Andersen JB, Wandall-Holm MF, Magyari M. Pregnancy outcomes following maternal or paternal exposure to teriflunomide in the Danish MS population. Mult Scler Relat Disord 2022; 59:103529. [DOI: 10.1016/j.msard.2022.103529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/05/2022] [Accepted: 01/14/2022] [Indexed: 11/27/2022]
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Gbaguidi B, Guillemin F, Soudant M, Debouverie M, Mathey G, Epstein J. Age-period-cohort analysis of the incidence of multiple sclerosis over twenty years in Lorraine, France. Sci Rep 2022; 12:1001. [PMID: 35046460 PMCID: PMC8770673 DOI: 10.1038/s41598-022-04836-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/31/2021] [Indexed: 01/21/2023] Open
Abstract
Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system. An increase in MS incidence over time is reported in several regions of the world. We aimed to describe the evolution of the annual MS incidence in the Lorraine region, France, from 1996 to 2015 and to analyze potential components of a possible change by a temporal effect of age at MS onset, MS onset period, and birth cohort, overall and for each sex. Cases were identified from ReLSEP, a population-based registry of MS cases living in Lorraine, northeastern France, with MS onset between 1996 and 2015. Age-period-cohort modeling was used to describe trends in MS incidence. Annual age- and sex-standardized incidences were relatively stable: 6.76/100 000 population (95%CI [5.76-7.91]) in 1996 and 6.78/100 000 (95%CI [5.72-7.97]) in 2015. The incidence ratio between women and men was 2.4. For all time periods, the peak incidence occurred between ages 25 and 35 years. Age-period-adjusted cohort and age-cohort-adjusted period analyses did not reveal a period or cohort effect. The incidence of MS remained stable over the study period in Lorraine, and we could not identify any particular effect of disease onset period or birth period on this evolution.
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Affiliation(s)
- Brigitte Gbaguidi
- Inserm, CIC-1433 Clinical Epidemiology, CHRU de Nancy, University of Lorraine, 9 Allée du Morvan, 54505, Vandoeuvre-les-Nancy, France
| | - Francis Guillemin
- Inserm, CIC-1433 Clinical Epidemiology, CHRU de Nancy, University of Lorraine, 9 Allée du Morvan, 54505, Vandoeuvre-les-Nancy, France
| | - Marc Soudant
- Inserm, CIC-1433 Clinical Epidemiology, CHRU de Nancy, University of Lorraine, 9 Allée du Morvan, 54505, Vandoeuvre-les-Nancy, France
| | - Marc Debouverie
- Département of Neurology, CHRU de Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - Guillaume Mathey
- Département of Neurology, CHRU de Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - Jonathan Epstein
- Inserm, CIC-1433 Clinical Epidemiology, CHRU de Nancy, University of Lorraine, 9 Allée du Morvan, 54505, Vandoeuvre-les-Nancy, France.
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Koch-Henriksen N, Magyari M. Apparent changes in the epidemiology and severity of multiple sclerosis. Nat Rev Neurol 2021; 17:676-688. [PMID: 34584250 DOI: 10.1038/s41582-021-00556-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 02/08/2023]
Abstract
Multiple sclerosis (MS) is an immunological disease that causes acute inflammatory lesions and chronic inflammation in the CNS, leading to tissue damage and disability. As awareness of MS has increased and options for therapy have come into use, a large amount of epidemiological data have been collected, enabling studies of changes in incidence and disease course over time. Overall, these data seem to indicate that the incidence of MS has increased, but the course of the disease has become milder, particularly in the 25 years since the first disease-modifying therapies (DMTs) became available. A clear understanding of these trends and the reasons for them is important for understanding the factors that influence the development and progression of MS, and for clinical management with respect to prevention and treatment decisions. In this Review, we consider the evidence for changes in the epidemiology of MS, focusing on trends in the incidence of the disease over time and trends in the disease severity. In addition, we discuss the factors influencing these trends, including refinement of diagnostic criteria and improvements in health-care systems that have increased diagnosis in people with mild disease, and the introduction and improvement of DMT.
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Affiliation(s)
- Nils Koch-Henriksen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. .,The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark.,Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
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